Full text of "Southern Medical and Surgical Journal"

SOUTHERN 



MEDICAL AND SURGICAL JOURNAL. 






EDITED BY 

HENRY F. CAMPBELL, A.M., M. D., 

PROKES-OR OK BPECIAL AND COMPARATIVE ANATOMY IN TBI MEDICAL COLLEGK OF GEORGIA 



ROBERT CAMPBELL, A.M..M.D., 

DBMOSrtTRATOB OF ANATOMY IN THE MEDICAL COLLEGE 




MEPICAL COLLEGE OF GEORGIA. 






YOL. XIV.— 1858.— NEW SERIES. 



AUGUSTA, G A: 

J. MORRIS, PRINTER AND PUBLISHER. 

1858. 



;.*ff 



SOUTHERN 

MEDICAL AND SURGICAL JOURNAL. 

(SEW SERIES.) 

Vol. XIV.] AUGUSTA, GEORGIA, JANUARY, 1558. [No. 1. 

ORIGINAL AXD ECLECTIC. 

AKTICLE I. 

A Clinical Lecture upon some of the Effects of Intemperance; de- 
livered at the Augusta City Hospital, by L. A. Dugas, M. D., 
aud written out by special request 

Gextlemex, — 

The case of the woman we have just left in a moribund condi- 
tion, is well calculated to arrest our attention. This woman, 
who now seems to be about 40 years of age, and who presents to 
us so lamentable a picture of the effects of vice, is one of the 
frail sisterhood, who, having in her youth forfeited her social 
position, fled from the parental roof to a den of infamy, and has 
been ever since endeavoring to drown her remorse in alcoholic 
and other narcotic potations. She was a short time since taken 
from a miserable negro hovel and brought here to die and to 
be buried at the expense of the city. You may have observe :1 
when we first saw her, a few days ago, that she was still able to 
speak, although her articulation was slow and somewhat diffi- 
cult — that she lay upon her back without the power to move 
either her limbs or her trunk, but still retaining her sensibility 
as well as her mental faculties comparatively unimpaired — that 
she was not laboring under paralysis, properly so called, but 
that she was suffering from a real exhaustion of nervous power 
throughout the whole system, which had been gradually pro- 
s. — VOL. xiv. no. i. 1 



4 DuGAS^on Effects of Intemperance. [January, 

gressive, and without any indication whatever of local organic 
disease. She now appears to be asleep with her eyes half open, 
but breathes quietly, and presents none of the phenomena of 
apoplexy. She has passed into this state gradually since you 
last saw her, and her small and rapid pulse indicates an early 
termination of this process of resolution. The energies of life, 
long undermined by dissolute habits, have gradually yielded, 
and she now dies evidently from mere nervous exhaustion. 

It is in the presence of cases like these that the physician re- 
alizes in its fullest force one of the evils — perhaps, alas, a neces- 
sary evil — of the social system of refined civilization ; I mean 
that which condemns to perpetual infamy the unfortunate female, 
who, in a moment of infatuation yields to the designs of an 
artful and heartless deceiver ! She soon realizes her dreadful 
error, and yet dares not, as she had always done before, appeal 
to the parents who would affectionately overlook any other 
guilt and endeavor to palliate it — for sh* knows that this is an 
unpardonable sin, even in the sight of those who gave her birth ! 
Oh, if she could only be allowed to throw herself upon her 
knees, implore their forgiveness, and receive from them even a 
look of kindness, she would do so, continue to dwell with them, 
and probably lead a virtuous life the remainder of her days. 
But, no ; she must fly, or be driven from the midst of those she 
loves, and be an outcast among the vilest refuse of society, 
where, with a broken heart and lacerated conscience, she natur- 
ally seeks relief in the obtunding use of narcotics of one kind or 
another! The effects of these are before us — we here behold, 
however, only one of the sad consequences of intemperance, and, 
if you will pardon me for dwelling upon a topic, perhaps trite, 
I will take this opportunity to make a few comments upon some 
of the evils of intemperance to the individual who indulges in 
this vice, to his offspring, and to his race. 

I beg leave, Gentlemen, at once to say that I am not one of 
those who think that a good cause is ever benefitted by exag- 
geration and by positions unsustained by truth. I would not 
therefore have you to give credence to the ridiculous stories 
about alcohol being found in the ventricles of the brain, 
about the spontaneous combustion of drunkards, &c. — nor would 
I tell you that a moderate and well regulated use of intoxicating 



1858.] Dugas, on Effects of Intemperance. 5 

beverages is always injurious, when the most casual observation 
might falsify the assertion. It is of intemperance I wish to speak, 
and not of temperance, — and yet, I am free to say, that if a man 
cannot drink without drinking too much, he ought not to drink 
at all. 

There are two forms of intemperance — the one periodical and 
the other continued. Those addicted to the former will drink 
profusely for days or weeks, until the stomach rebels and rejects 
the potations, and they cannot take any more. They will then 
suffer greatly, mentally and physically, a few da}^s, and gradual- 
ly get over their "spree," to resume it again after the lapse of 
weeks, months, or even years. This is the most inveterate, the 
most incurable form of intemperance. Indeed, I may say that 
I look upon such cases as utterly hopeless, for I have never 
known a single instance of permanent reformation, in those ad- 
dicted to periodical intemperance. The victims of this form are 
more violent and uncontrolable, more disagreeable and danger- 
ous to society, more subject to delirium tremens, and more 
liable to permanent insanity, than habitual inebriates. 

The continued form of intemperance is that in which the 
individual habitually takes too much ; some will attend to their 
business during the day more or less efficiently, and yet be sur- 
feited every night — others are sober enough to attend to 
business only in the forenoon — and, finally, there are many 
who can scarcely ever be found entirely sober. I recollect a 
case in court in which a will was set aside upon the testimony 
of the neighbors that the maker had not been sober enough in 
ten years to know what he was about ! The will had been 
executed six or seven years before his death. And yet this 
man lived seventy-five years, and had been intemperate all his 
life! I believe it to be a general rule, that the habitually intem- 
perate live longer than those who are only periodically so. But 
the habitual inebriate is more liable to liver disease, to dropsy 
and to rheumatism — neither of which affections have I ever 
known cured under such circumstances. The periodical drunk- 
ard is more apt to be carried off by an attack of mania-a-potu, 
or of some other acute disease. "While, with most persons in- 
temperance induces more or less of plethora and corpulency, 
there are some in whom it produces an opposite effect, and we 



6 Du 'GAS, on Effects of Intemperance. [January, 

find these pale or sallow, and thin. When it terminates in 
dropsy, this seems to be in consequence of hypertrophy of the 
cellular tissue of the liver, by which the portal veins are com- 
pressed to such a degree as to impede the free passage of blood, 
and to cause its undue accumulation in the intestinal canal and 
its investing membrane. In such cases the vessels may relieve 
themselves by an abundant secretion from the mucous surface, 
constituting diarrhoea, or by an exhalation into the peritoneal 
cavity, so as to produce dropsy. Either of these symptoms may 
be, in general, regarded as the precursor of early dissolution. 

Intemperance deeply affects the nervous system of animal 
life, as is evinced by the uncertain gait, the tremulous hand, 
convulsions, and various painful diseases. But the brain, this 
great seat of intellect and of the moral perceptions, reveals its 
baneful influence under the forms of mania-a-potu, perverted 
reason, and moral depravity. Who has not seen instances in 
which the noblest intellect and the most refined sense of pro- 
priety have been thus changed into stupid vagaries and knavish * 
as well as brutal propensities ? With reason dethroned and the 
moral perceptions blunted, the victim drags a miserable exist- 
ence himself, and embitters that of all who loved and esteemed 
him! 

Let us now look at some of the effects of Intemperance upon 
the offspring and upon the race. I think it susceptible of easy 
demonstration, that the children of an habitual inebriate will 
have but little stamina — that is to say, that their powers of re- 
resistance to morbid influences will be more or less impaired, 
and that they will therefore be more liable to disease than they 
would otherwise have been ; that they will often be scrofulous, 
and occasionally insane, or idiotic. These effects will, moreo- 
ver, become more and more apparent the longer the parent has 
been a drunkard — so that if he have a large family during his 
intemperance, the deterioration of his children will be progress- 
ive, and the last may be so puny as never to reach maturity, 
although the first may be comparatively healthy. Nay, there 
are some drunkards, whose own constitution being poor, will 
rear a few children, and then lose in infancy or childhood all 
those they may subsequently have. Just reflect a little upon 
the condition of the families in your respective neighbourhoods 



1 858.] Dugas, on Effects of Intemperance. 7 

and I think that each one of you will recall to mind some illus- 
tration of the correctness of these propositions. 

Well, Gentlemen, what is true with regard to the influence of 
intemperance upon the oflspring of the first drunken parent, 
becomes most painfully so if the offspring himself follow the 
example of his father and become also a drunken parent. The 
issue of this second generation of drunkards will, in all proba- 
bility, be few in number, and their stamina will be so much 
impaired that it will be with the utmost difficulty that any of 
them can reach maturity. Let us follow this third generation, 
and if it perchance also take to the bottle, it will be the last of 
that family — for I do not hesitate to proclaim it as a law of 
almost universal applicability, that three successive gene-rations of 
drunkards will leave no issue ! The third generation may have 
children, but not one of these will be reared to manhood ! — 
This may appear to you a startling announcement; but I believe 
that you will find it based upon truth. As I have long since 
entertained these views of the effects of intemperance upon fami- 
lies, I would like to adduce some of the evidence I have collect- 
ed from personal observation, were it not manifestly improper 
to lift the veil from the private history of families who have 
passed away. But we can, without the least impropriety, study 
the history of families, in connection with that of the race to 
which they belong, and if you will bear with me a few moments 
more, I will endeavor to illustrate my proposition by a reference 
to the sad history of our aboriginal savages. 

I need not repeat what you all know — that tribe after tribe of 
the children of the forest have vanished from before the sun — 
and still continue to do so with awful rapidity. Why is this 
so ? Is there anything in their physical organization that inca- 
pacitates them for the perpetuation of their species, or race, if 
you prefer the term ? Certainly not. Then, I again ask the 
question, why is it so? In order to answer this, let us examine 
the influences that have been brought to bear upon this race in 
the different portions of our continent, and let us see if they 
have suffered equally in these several regions. 

America has been colonized by two classes of people : in the 
one we find the Spaniards, the Portuguese, and the French ; in 
the other the British and their American descendants. Now 



8 Dug -as, on Effects of Intemperance. [January, 

how have the Indians fared under the dominion of these two 
classes ? Under the former they have increased and multiplied — 
whereas, under the latter they have been annihilated! The 
Spanish, the Portuguese, and the French, are temperate people, 
and the British and Anglo-Americans intemperate — and while 
the former have propitiated the good- will of the savages, have 
fraternized with them, have civilized and christianized them, 
probably as far as their nature will permit; the latter have done 
neither, but have, on the contrary, introduced among them their 
own vices and intemperance, and driven them from their hunt- 
ing grounds to perish like outcasts. Contrast the history of the 
Indian in Mexico, with that of the same race in the United 
States — or even in Georgia. Towards the close of the last cen- 
tury the population of Mexico was about four millions, of which 
the pure Indian element constituted about two millions. — The 
population of that Eepublic is now about seven millions, of 
whom at least four millions are pure Indians, two millions mix- 
ed races, and one million pure castillians. Sixty years ago, one 
half of the State of Georgia was peopled with savages — and 
where are they now? With the exception of a small remnant 
of Cherokees and Creeks, who have been driven across the Mis- 
sissippi, these mighty tribes have ceased to exist! In South 
America, it is highly probable that the Indian population is 
fully as great as it ever was, if not greater. Under the French 
dominion, the Canada Indians prospered as they do in South 
America ; but they have been deteriorating and dwindling away 
rapidly ever since the British have acquired those provinces. 
Look at the influence of the boasted civilization introduced 
by the drinking races among the Sandwich islanders! The 
third generation of drunkards is now living there, and it is esti- 
mated that in fifteen or twenty years more there will not be left 
a solitary representative of that people. The sailor with his 
bottle has doubtless had more followers than the missionary 
with his Bible in that unhappy land. Look at the dissolute and 
drunken habits of our frontier Indians, and you cannot be long 
in discovering the true reason of their extinction. The same 
baneful influence operates upon the free blacks who seek refuge 
in the large cities at the North. The climate, may, it is true, 
account in some degree, for the great mortality among them ; 



1858.] DtJGAS, on Effects of Intemperance. 9 

but intemperance is unquestionably their greatest enemy. The 
philanthropist will look in vain for a solution of these stubborn 
facts, unless he attribute them to intemperance, the most potent 
destroyer of mankind. 

I hope, gentlemen, that you will pardon the length of the di- 
gression into which I have been insensibly led from the case 
under our special consideration, I did not intend to make you 
a temperance address — but I never see a victim of this awful 
propensity, without feeling that something ought to be done to 
put a stop to it. I have therefore endeavoured to direct jour 
attention in as forcible a manner as I could under the inspira- 
tion of the moment, to some of its pernicious effects. You are 
destined, I trust, to exert some influence upon the communities 
in which you may fix your abode. No member of society has 
it more in his power to do good, than the intelligent and moral 
physician. The subject before us affords a noble field for the 
exercise of enlightened benevolence. Unite your efforts to ex- 
tirpate this, as you will do to stay the ravages of other diseases. 
Let us look upon intemperance as a disease and treat it as such. 
Must it not indeed be a veritable mental derangement, that 
would lead a man irresistibly, as it were, to the destruction of 
self, of family and of race ? Let us but call it a species of in- 
sanity^ and the remedy will suggest itself immediately. 

That intemperance is a disease, will, I think, be very general- 
ly conceded by enlightened physieians. Like other morbid/ 
conditions, it may be inherited, or acquired. When derived by 
inheritance, the patient may not be so much to blame as when 
it is acquired by improper indulgence. It nevertheless, in all 
cases, reveals a morbid condition of the brain, not unlike that 
which constitutes other forms of monomania. The patient is as 
irresistibly impelled to drink, as some monomaniacs are to thieve, 
notwithstanding all the influences of education and of other in- 
centives to good conduct. Some will say that it is only a 
depraved appetite, or a want of proper self control — but this does 
not change the matter. This depraved appetite, or this inability 
to control one's propensities, is a morbid state — often as much 
deplored by the patient himself, as by his friends. I have fre- 
quently heard these patients in their lucid intervals, declare 
most solemnly that they would cheerfully give all they possess- 



10 DuGAS, on Effects of Intemperance. [January, 

ed to gat rid of this dreadful propensity. And I believe that 
they were sincere. 

But how shall we treat such cases ? Place them in an asy- 
lum as you do those affected with other forms of insanity ; and 
let them undergo such treatment as may be deemed best adapted 
to the restoration of the brain and nervous system to their pro- 
per and normal functions. 

I am aware that, under existing circumstances, this cannot be 
done. We- need legislation upon the subject, before we can 
carry out our views; and I can see no good reason why some 
men should be sent to the lunatic asylum, and their property be 
placed in the hands of trustees, until they be relieved of certain 
forms of insanity, while others equally injurious to society, and 
unable to manage their affairs, in consequence of intemperance — 
another species of insanity — are allowed to run at large, squand- 
ering their estate, embittering the lives of their family, annoying 
whole communities, and committing every variety of crime. I 
verily believe that a majority of the inmates of lunatic asylums 
would be found less dangerous and less annoying to the commu- 
nities from which they were sent than any equal number of 
drunkards. 

I think that the legislature of New York has taken the initia- 
tive in chartering a voluntary Asylum for Inebriates. This is 
a step in the right direction, and may of itself be productive of 
much good. But inebriates ought to be put upon the same 
footing as other lunatics. Let a writ of lunacy bring them be- 
fore a jury — and upon conviction, let them be ordered to the 
asylum, and their estate be placed in the custody of trustees un- 
til their recovery — and I firmly believe that permanent cures 
may in very many instances be the result. 

The sufferers from intemperance are entitled to our sympathy, 
and we should come to their relief, however loathsome they may 
be in the sight of the non-professional members of society. Let 
us not apply to them degrading epithets and treat them like 
brutes ; but on the contrary, extend to them the hand of kind- 
ness and the offices of christian charity. It is thus alone that 
we may obtain their confidence and become useful to them. 

The fact being once established by the legislation of the coun- 
try, that intemperance is a disease, and that it can only be treated 



1858.] Battey, on Sub- Carbonate of Bismuth. 11 

successfully in an institution humanely and properly devised for 
this special purpose, much of the odium that now attaches to 
this condition, and which might otherwise result from the con- 
finement, will be removed. I believe that such a system would 
do more good than all our temperance societies. The combined 
influence of both, however, would in all probability erase from 
our national escutcheon one of its foulest blots. If you agree 
with me, let us unite our endeavors to bring about in our re- 
spective communities such a state of public opinion as may result 
in the legal establishment, in every state, of Asylums for the 
Inebriate. 



AETICLE H. 



Sub- Carbonate of Bismuth. — New Mode of Preparation. By Rob- 
ert Battey, M. D., of Rome, Ga. 

The attention of the Profession having been called to the sub- 
carbonate of bismuth — in connection with the operose process of 
Prof. Hannon, of Brussels, for obtaining it — it would seem de- 
sirable that a simple and easy mode of manipulation should be 
more generally known. 

The repeated fusion of the impure bismuth with nitrate of 
potassa, to free it from arseniurets and sulphurets, with which it 
is usually contaminated, may well be replaced by the simple 
solution in nitric acid, and precipitation (as sub-nitrate) by dis- 
tilled water. This precipitate, if not absolutely pure, is suffi- 
ciently so for all medical purposes — it should be well washed 
with distilled water. By this process the impurities are oxidized, 
and rendered soluble in water, or left behind undissolved by 
the acid ; in both cases they are gotten rid of very satisfacto- 
rily. 

To prepare the sub-carbonate, dissolve the sub-nitrate in a 
sufficiency of nitric acid to effect the solution when warmed — 
decant the clear liquid, and add it slowly to a filtered solution 
of carbonate of soda — collect the precipitate upon a filter — wash 
well with distilled water, wrap in filtering paper, and dry by a 
gentle heat. 



12 Battey, on Subcarbonate of Bismuth. [January, 

For the physician, it will be convenient to use the sub-nitrate 
which he has upon his shelf. If it be entirely soluble in nitric 
acid, without effervescence, and is not clouded on the addition 
of a few drops sulphuric acid, it may be esteemed pure ; other- 
wise, decant the clear solution and precipitate with distilled 
water to render it so. 

Eain-water, boiled and filtered, may be used in place of the 
distilled water. 

A sample of the sub-carbonate, made by the above process, was 
subjected to Marsh's test, and found entirely free of arsenic. 

[By reference to the October number of the 13th volume of 
this Journal, page 625, Mr. Hannon's mode of preparation will 
be found. Compared with the above, it is difficult and incon- 
venient, only practicable to the regular chemist — while that 
proposed and effected by our contributor is easily adopted by 
the ordinary practitioner, and is therefore, in our opinion, pre- 
ferable. 

This sub-carbonate of bismuth, if it answers the expectations 
which we have every right to entertain from a soluble salt of 
this metal, is destined to become a most valuable therapeutic 
agent. The insoluble salt, the sub-nitrate, is every day become 
ing more extensively and variously applied, and the results of 
its action, in a variety of cases, are often very surprising — even 
startling to the practitioner. Its action, however, is generally 
slow, and it is inefficient in many cases on account of its insolu- 
bility. "The sub-carbonate is soluble in the gastric juice, its 
action is rapid, it produces no sensation of weight at the stomach, 
it rarely constipates, colors the stools less than the sub-nitrate, 
and may be employed for a long time without oppressing the 
stomach. The action of the sub-carbonate appears to be seda- 
tive during the first days of its employment, and subsequently 
to excite all the phenomena which result from the action of 
tonics." 

We quote farther, from the article above mentioned, in order 
that our readers may have before them, in connection with this 
new mode of preparation proposed by Dr. Battey, the whole 
amount of facts at present known in relation to the therapeuti- 
cal action of the sub-carbonate of bismuth. 



1858.] Campbell's Classification of Febrile Diseases, &c. 13 

"As to its therapeutical action, it may be noted that all cases 
of gastralgia consecutive upon phlegmasia of the digestive pas- 
sages, cases in which the tongue is red and pointed, and cases in 
which the digestion is laborious and accompanied with putrid 
or acid eructations, or in which there is a tendency to diarrhoea 
or spasmodic vomiting, demand the employment of the sub- 
carbonate of bismuth. This salt is also required in the vomiting 
of children, whether caused by dentition or succeeding to fre- 
quent fits of indigestion, and in the diarrhoea of weak children, 
especially when occurring at the time of weaning. One great 
advantage possessed by the sub-carbonate of bismuth is, that it 
neutralizes the acids in excess which are found in the stomach. 
The sub-nitrate, as is well known, fails always in this respect 
In all the cases where the subcarbonate has been taken, the 
pain in the digestive passages is first found to disappear ; then 
the eructations cease, together with the vomiting or diarrhoea; 
the digestion becomes less and less laborious, the tongue gradu- 
ally receives its normal form and color ; and if the use of the 
subcarbonate is continued, the appetite increases from day to day, 
the yellow tint of the countenance disappears, and the face be- 
comes colored at the same time as it ceases to be shrivelled. 

The subcarbonate of bismuth is perfectly insipid, and excites 
no repugnance. It is given before meals. Adults take it in a 
little water, and children in honey. It may also be made into 
lozenges. The dose for adults is from one to three grammes, 
taken three times a day in increasing doses."] 



ARTICLE III. 



Classification of Febrile Diseases by their Relation to the Nervous 
System* By Henry F. Campbell, M. D., Professor of Anat- 
omy in the Medical College of Gerogia — and Chairman of 
Committee on Nervous System in Febrile Diseases. 

During the examination of our subject since the time of our 
appointment as a special committee, by this Association, we 
have been, at each step, more and more impressed with its 
importance, and at the same time with the extreme difficulty 
attending its full, clear, and thorough elaboration. "A man," 
says Lord Bacon, " must collect facts, in order to know the law 

* A partial Report read before the American Medical Association, Nashville, 
May, 1857. 



14 Campbell's Classification of Febrile Diseases, &c. [January, 

of facts ;" diligently and earnestly engaged for the year past, in 
collecting and interrogating the facts which have a bearing on 
the important subject of Febrile Diseases, in the relation assign- 
ed us for examination, we have scarcely had time to do more 
than note, here and there, the gleam of truth which has been 
evolved during a bare hasty collocation of data ; much less to 
determine satisfactorily any fixed law in relation to the vast 
subjects involved in the investigation. That such laws will be 
recognized, and that the careful generalization of the facts will 
be productive of important, fruitful results, we have already 
seen enough fully to persuade us. Pleading then the magnitude, 
as well as the embarrassments of the subject, we ask of this As- 
sociation the previlege of having our special committee contin- 
ued for another year, allowing us at present to lay before this 
body a few conclusions arrived at, as the result of the investiga- 
tion in its present state of progress. 

I. As all the normal phenomena of the living organism are 
known to occur under the superintending influence of the ner- 
vous system, and are dominated by it, so it is but rational to 
regard all morbid actions as being more or less influenced in 
their manifestations by aberrated nervous action. In that class 
of diseases ordinarily designated fevers, our researches and ob- 
servations have led us to the confident belief that the above law 
applies with sufficient prominence to constitute the basis of their 
classification, and we would here respectfully claim for it, that 
it is the only reliable basis of their clasification, and further, that 
in its more extended application, it will hereafter be found to 
constitute what may be called par excellence, the Law of Febrile 
Diseases. Simply to assert the recognition of this law, and to 
suggest a new and more comprehensive classification of Fevers 
based upon it, is the sole object of the present brief exposition. 

II. As in the Nervous System, we recognize two grand de- 
partments, viz : 1st. The Cerebro-spinal System, all the normal 
actions of which are subject to cessations and interruptions ; and 
2dly. The Ganglionic System, all the normal actions of which 
are of a continuous and ^interrupted character, so in the mani- 
festations of febrile diseases, do we distinctly recognize two grand 
distinguishing characteristics respectively typifying the normal 
actions of these two systems of nerves : thus a character of par- 



1858.] Campbell's Classification of Febrile Diseases, &c. 15 

oxysm obtains in certain cases, while a character of continuous- 
ness as plainly marks the others. 

III. Again : as in the Cerebro-spinal System, we find that 
its normal action pertains almost exclusively to sensation and 
to motion, with only a secondary and comparatively somewhat 
remote influence (which we have termed Excito-Secretory) upon 
nutrition and secretion, while in the normal action of the Gan- 
glionic System the entire function is known to be, to preside 
over nutrition and the secretions ; so in paroxysmal fevers do we 
find intense pain, modified sensation, and symptoms allying 
them to neuralgic and convulsive diseases very prominent, 
while in continued fevers, modified nutrition and altered secre- 
tion, are the marked and most prominent characteristics. We 
would, therefore, announce as our classification of febrile diseases, 
two grand divisions of fevers corresponding with the two grand 
divisions of the nervous system, thus : — 

I. Cerebrospinal Fevers. 
All Paroxysmal. The secretions und nutrition only seconda- 
rily affected. 

IT. Ganglionic Fevers. 
All Continued. The secretions and nutrition primarily affec- 
ted. 

I. Under the head of Cerebrospinal Fevers, we would 
place the whole family of Paroxysmal Fevers, whatever type 
they, may assume,* and also the various forms of neuralgia, 
which are nearly always intermittent, as well as the sthenic forms 
of Traumatic Fever, together with the Fever accompanying 
simple Pharyngitis, Pneumonitis, Dysentery, and many other 
diseases of malarial districts. 

II. Under the head of Ganglionic Fevers, or Fevers of 
the Secretory System of Nerves, we think that we find 
ample ground for bringing together many diseases heretofore 
widely estranged from each other. Thus, as the archetypal 

* The primitive location of these fevers, in the cerebro-spinal system, vras de- 
veloped by Prof. L. D. Ford, of the Medical College of Georgia, in the Soulhcm 
- rgical Journal, in 1836, and called by Maillot, "Cerebro-spinal 
Intermittent Irritations," 



16 Campbell's Classification of 1 diseases, <tc [January, 

forms of ganglionic fevers, we place at the head of the list. 
phus and typhoid fever,* then, allied to these in various de- 
grees of affinity, but all equally, in the one essential element, 
that they present themselves as manifestations of disease through the 
Gan ^sierra, are variola, scarlatina, rubeola, varicella, and 

many other forms of eruptive fevers, heretofore not classified by 
nomologists. All of these last diseases are marked by fever of a 
nued or non paroxymal character, all present marked aber* 
rations of nutrition and secretion, and each has its own peculiar 
eruptive character; and, further, each one is definitely self 
ted in its duration, as yet, no remedical interference having 
been found competent to arrest or shorten their progre- 

TTe will here make the remark, that we do not wish to be 
mistaken as classifying these diseases in relation to their eruptive 
feature, but only as signifying a recognition of the common 
influence of the secretory system of nerves in all of them by the 
eruption. In typhoid fever itself, it must be recollected that 
the eruption is not a prominent feature, and yet, we consider the 
secretory system of nerves primarily deeply affected, and place 
this at the head of the list, notwithstanding the fact, that the 
ganglionic implication manifests itself but little upon, the skin and 
mainly in the intestinal canal.f 

It may be asked, if all of these fevers are due to aberration in 
the innervation of the ganglionic or secretory system of nerves, 
why should they present such marked specific differences ? A 
satisfactory answer may be given thus : that specificity of mor- 
bific cause must rationally be expected to secure a specificity of 
morbid manifestation ; thus the virus of variola, when taken 
into the system, gives rise to the morbid manifestations peculiar 
to smallpox, while the morbific influence (of whatever nature 
it may be) of typhoid fever, produces a specific form of disease 
entirely different, but not the les3 for that reason, locatable in 

* As first developed in an essay entitled: "An Inquiry into the Nature of Ty- 
phoidal Fevers, based tepoa a Consideration of their History and Pathology? pre- 
sented to the American Medical Association at its Session of May, IS 5.3, by Henry 
npbeU, Chairman of Committee on Typhoid Fever. The implication of the 
ganglionic system of nerves, in typhus and typhoid fever, has been, in the above 
essay, argued at length. 

.uiry, <fcc, pp. 53 and 54. 



1858.] Campbell's Classification of Febrile Diseases, &e. 17 

parts of the organism entirely controlled by the secretory ner- 
vous system. 

Blending of Types of Fever. — Much interest has been 
taken by this Association, for the last five years, in the subject 
of the Blending of the Types of Fever. We would claim for 
the present Pathology and Classification of Fevers, that it is the 
only one which admits of any plausible explanation of the mys- 
terious phenomena comprehended under the term, "Blending 
of Types ;" thus, a cerebro- spinal or paroxysmal fever may as- 
sume, under certain circumstances, some of the characteristics 
of some one or other of the forms of continued fever. This we 
hold can be explained by attributing it to a propagation of the 
irritation, originally located in the spinal marrow, to the gan- 
glia of the secretory system. Then, again, the reverse may 
obtain ; we may find, and do often find, in continued fevers, 
especially in malarious districts (whether the case be typhoid 
fever, rubeola, or scarlatina.) intermittent paroxysms, interrupt- 
ing the even course of the continued, form, sometimes obscuring 
the diagnosis, and making it necessary to modify the treatment. 
The use of quinine, it is well known, will generally break up 
these paroxysms, but not in the least modify the course of the 
continued fever. In the first of these cases, the morbific influ- 
ence has been "centripetal" and in the second "centrifugal," 
and thus the "blending of types" may be rationally and phil- 
osophically explained. 

We are aware that, in presenting thus a condensed exposition 
on the obsoure subject of " The Nervous System in Febrile 
Diseases," without more argument and fuller elaboration, we 
are running the risk of being charged with "bare assertion," 
but we will honestly avow that each proposition has been earn- 
estly and carefully considered, keeping constantly in view all 
the phenomena of febrile diseases — comparing them faithfully 
with the normal actions of the two grand departments of the 
nervous system. 

It will be remarked, that we have not attempted to define 
what is the exact morbid condition of the nervous centres, or 
of the nerves, which gives rise to the phenomena in the two 
classes of fever. Such a process of reasoning we have careful- 
ly abstained from, because such a discussion would be conver- 



18 Indigenous Races. [January, 

sant about subjects which cannot as yet be said to have been 
brought within the legitimate domain of science. We can only 
as yet trace the effects to their causes ; it is a different thing to 
discuss the nature of the causes themselves ; and as Professor 
Whewell has made a distinction between the Laws of Phenom- 
ena and the Causes of Phenomena, so we only here claim to 
have recognized a Law, leaving the more recondite inquisition 
into the Causes, for a more advanced and enlightened age of 
science. In conclusion, we will say, we may have been, in the 
above exposition, unfortunately obscure in presenting to others 
what has become a clear and well defined conviction to us ; but 
in the pertinent language of another,* whose deep philosophy 
has charmed us, while it has been of unspeakable service to us 
in many of our investigations, we will say, that " to our mind 
this doctrine stands firm and impregnable — assailable by no 
known fact consistent with every established truth." 



ARTICLE IV. 



Indigenous Races of the Earth ; or a few Chapters of Ethnological 
Inquiry ; including Monographs on special departments of 
Philology, Iconography, Cranioscopy, Paleontology, Patholo- 
gy, Archeology, Comparative Geography, and Natural Histo- 
ry : contributed by Alfred Maury, Francis Pulszky, and 
J. Aitken Meigs, M. D., presenting fresh investigations, 
documents and materials ; by J. C. Nott, M. D., and Geo. K. 
Gliddon, authors of "Types of Mankind. Philadelphia: 
J. B. Lippincott & Co. 1857. Large 8vo., pp. 655. 



Although we have had this volume upon our table for some 
length of time, circumstances have prevented an earlier notice 
of it. As indicated by the title page, it is made up of contribu- 
tions from several writers — and we may add, from men of well 
established erudition. The first paper is by A. Maury, " on the 
distribution and classification of Tongues, — their relation to the 
geographical distribution of Paces ; and on the inductions which 
may be drawn from these relations." The second by T. Pulszky, 
being " Iconographic researches on Human Paces and their Art." 

* Dr. M'Cosh, on the Method of the Divine Government. 



1858.] Indigenous Races. 19 

The third by J. A. Meigs, on the " Cranial characteristics of the 
Kaces of Men." The fourth by Dr. J. C. Nott, on " Acclimation ; 
or the comparative influence of Climate, Endemic and Epidemic 
diseases, on the Kaces of Men." The fifth by G. K. Gliddon, 
entitled, " The Monogenists and the Polygenists ; being an ex- 
position of the doctrines of schools professing to sustain dogmati- 
cally the unity or the diversity of the human races ; with an 
inquiry into the antiquity of mankind upon Earth, viewed 
chronologically, historically and palseontologically." And, final- 
ly, the sixth, also by Mr. Gliddon, is a " Commentary upon the 
principal distinctions observed among the various groups of 
Humanity — and on the Geographical distribution of the Simiae 
in relation to that of some inferior types of Men." It will thus 
be seen that however much these disquisitions may interest the 
Naturalist, the contribution by Dr. Nott is the only one which 
strictly comes within the domain of medical studies, and should 
alone, therefore, occupy our attention as conductors of a period- 
ical devoted exclusively to medicine. We may, nevertheless, be 
permitted to express our appreciation of the learning displayed 
by the other contributors, and although we cannot admit the cor- 
rectness of all their views, we derived especial pleasure from the 
perusal of Mr. Pulszky's interesting sketch of the history of the 
fine arts, as illustrative of national instincts or proclivities. 

The following extract will indicate the object of Dr. Nott's 
paper : "In the preceding chapters, man has been viewed from 
opposite stand-points; and each new group of facts would seem 
to lead more and more directly to the conclusion, that certain 
distinct types of the human family are as ancient and as perma- 
nent as the Faunas and Floras that surround them. 

" We propose in the present chapter, to investigate of Accli- 
mation ; that is to say, of Eaces in their relations to Climate, 
Endemic and Epidemic Diseases ; and if it should be made to 
appear that each type of mankind, like a species of animals or 
plants, has its appropriate climate or station, and that it cannot 
by any process, however gradual, or in any number of genera- 
tions, become fully habituated to those of opposite character, 
another strong confirmation will be added to the conclusion 
above alluded to." 

While admitting that man, in common with certain of the 



20 Indigenous Races. [January, 

lower animals and plants possesses a sufficient degree of " consti- 
tutional pliability" to enable him to bear great changes of clim- 
ate, the author objects to the opinion entertained by many, that 
he (man) is a cosmopolite in the strict sense of the word. The 
Jews, who originally inhabited a region in which they were 
exposed to cold winters and warm summers, are well adapted 
to the dispersion to which they have been subjected, but "the 
Eskimau on the one extreme, and the Negro, Hindoo, and Malay 
on the other, have no power to withstand the vicissitudes of 
climate encountered in traversing the 70 deg. of latitude between 
Greenland and the equator. Each race has its prescribed salu- 
brious limits. The fair races of northern Europe, below the 
arctic zone, of which the Anglo-Saxon are impure descendants, 
will serve as another illustration. These races are now scattered 
over most parts of the habitable globe; and in many instances, 
they have undergone far greater physical changes than the Jews. 
The climates, for instance, of Jamaica, Louisiana, and India, are 
to them much more extreme than to the Jewish race. The 
Israelite may be recognized anywhere; but not so with the 
Scandinavian and his descendants in the tropics. The latter 
becomes tanned, emaciated, debilitated ; his countenance, energy, 
everything undergoes a change : and were we not familiar, from 
daily observation, with these effects of climate upon northern 
races, we should not suspect the original ancestry of many of 
the present inhabitants of hot climates. In these cases we be- 
hold, not simply a healthful modification of the physical and 
intellectual man, but a positively morhid degradation. The pure 
white man carried into the tropic, deteriotes both in mind and 
body; the average duration of his life is lessened ; and, without 
fresh importations, his race would in time become extinct. 
When, however, his descendants are taken back to their native 
climes, they revert to the healthful standard of their original 
types : the latter may have been distorted, but can never be 
lost, except in death", (p. 356.) 

The author then refers to the deteriorating effects of climate 
upon the English in Hindostan, the Indian Archipelago, Africa, 
the West Indies, and South America ; upon the Dutch in Bata- 
via and other Indian Islands ; upon the French in Algeria, &c; 
in neither of which colonies can the European cultivate the soil 



1858.] Indigenous Faces. 21 

nor engage in other laborious pursuits with impunity. " The 
negro, too, obeys the law of climate. Unlike the white man, 
his complexion undergoes no change by climate. While the 
white man is darkened by the tropical sun, the negro is never 
blanched in the slightest degree by a residence in northern lati- 
tudes. Like the quadrumana of the tropics, he is inevitably 
killed by cold ; but it never changes his hair, complexion, skel- 
eton, nor size and shape of brain." 

With regard to the effects of the climate of our Southern 
States upon Europeans, we find the following language : " Let 
us suppose that a thousand inhabitants of Great Britain or 
Germany should be landed at Mobile about the month of May, 
and one-third placed on the hills, one-third in the town, and 
the remainder in the fenny lands around the latter, and ask 
what would be the result at the end of six months. The first 
third would complain much of heat, would perspire enormous- 
ly, become enervated ; but no one would perhaps be seriously 
sick, and probably none would die from the effects of the clim- 
ate. The second third, or those in the city, if it happened to be 
a year of epidemic yellow fever, would, to say the least, be deci- 
mated, or even one-half might die, while the resident acclimated 
population were enjoying perfect health. The remaining por- 
tion, or those in the fenny district, would escape yellow fever, 
but would, most of them, be attacked with intermittent and 
remittent fevers, bowel affections, and all forms of malarial or 
marsh diseases ; fewer would die than of those in the city, but a 
large proportion would come out with broken down constitu- 
tions." " In our cotton -growing States, the malarial climate 

is by no means confined to the low and marshy districts; on the 
contrary, in the high, undulating lands throughout this exten- 
sive region, wherever there is fertility of soil, the population is 
subjected more or less to malarial diseases. These remarks ap- 
ply, as will be seen further on, more particularly to the white 
population, the negroes being comparatively exempt from all 
the endemic diseases of the South."* (p. 363.) 

* A medical friend (Dr. Gordon) who has had much experience in the diseases 
of the interior of Alabama, South Carolina, and Louisiana, has been so kind as to 
look over these sheets for me, and assures me that I have used language much 
too strong with regard to the exemption of negroes. He says they are quite as 
liable as the whites, according to his observations, to intermittents and d}'sen- 
tery." 



22 Indigenous Races. [January, 

We must differ with the learned author when he affirms that 
negroes are comparatively exempt from all the endemic diseases 
of the South. Such is certainly not the case in this section of 
Georgia, and in the adjacent portions of South-Carolina, and 
Alabama, where every planter knows that his negroes suffer 
equally with the whites, annual attacks of intermittent and re- . 
mittent fevers, dysentery, malarial pneumonia, &c. We had 
occasion a number of years ago, to point out the same error in 
the work of a distinguished Southern medical writer, and have 
since found these views to be pretty generally entertained by the 
physicians on our seaboard. The error seems to have originated 
in the fact that negroes are comparatively exempt from fever 
upon the rice and cotton plantations of the low-country, the field 
of their professional observation ; and this fact had led us long 
since to the inference that the low-country fever, is essentially 
different from that of the up-country. In the low country ne- 
groes become acclimated and comparatively exempt from fevers, 
but in the up-country no length of residence, nor even nativity, 
affords the least immunity either to the white or to the black 
man ; on the contrary, we may safely affirm that the liability to 
our fevers are in a direct ratio with the length of time the indi- 
vidual has resided in the malarial district, and that natives are 
the most susceptible. With yellow fever and perhaps low-coun- 
try fever, one attack usually secures immunity from a second : 
but with up-country fever, 'an attack one year is almost invari- 
ably followed by similar ones the subsequent autumns, and the 
oftener it is repeated, the more susceptible does the individual 
become. The negroes born and reared upon the plantations of 
the middle portions of Georgia and South- Carolina, are fully as 
liable to fever as new comers, and, we think, much more so. 
We know, from long observation, that in this city (Augusta), 
while we frequently see fevers among natives (white and black), 
it is exceedingly rare that we meet a case among our Northern 
people, who constitute a large portion of the permanent mercan- 
tile population. These views are sustained by the mortuary 
statistics of this city through a long series of years, published in 
the Southern Medical and Surgical Journal (volume for 1836). 
The low-country fever, like yellow fever, must then be essen- 
tially different from any form of fever in the upper sections of 



1858.] Indigenous Races. 23 

the Southern States. What constitutes the pathological differ- 
ence is yet to be determined, and should be studied by those 
who have the opportunity. It is an interesting subject of re- 
search, worthy of the attention of some of the eminent patholo- 
gists of the sea-board. 

When penning the remarks just made, we did not expect to 
find the author advocating pretty much the same views a little 
farther on. In order, therefore, to do him justice, we shall quote 
his own language : 

" The fact is so glaring, and so universally admitted, that I 
am really at a loss to select evidence to show that there is no 
acclimation against the endemic fevers of our rural districts. Is 
it not the constant theme of the population of the South, how 
they can preserve health ? and do not all prudent persons, who 
can afford to do so, remove in the summer to some salubrious 
locality, in the pine-lands or the mountains? Those of the 
tenth generation are just as solicitous on the subject as those of 
the first. Books written at the North talk much about acclima- 
tion at the South ; but we here never hear it alluded to out of 
the yellow-fever cities. On the contrary, we know that those who 
live from generation to generation in malarial districts become 
thoroughly poisoned, and exhibit the thousand Protean forms 
of disease which spring from this insidious poison. 

" I have been the examining physician to several life-insur- 
ance companies for many years, and one of the questions now 
asked in many of the policies is, l Is the party acclimated? 1 If 
the subject lives in one of our southern seaports, where yellow 
fever prevails, and has been born and reared there, or has had 
an attack of yellow fever, I answer, ' Yes.' If, on the other 
hand, he lives in the country, I answer, ' No ;' because there is 
no acclimation against intermittent and bilious fevers, and 'other 
marsh diseases. Now, I ask if there is an experienced and observ- 
ing physician at the South who will answer differently ? An 
attack of yellow fever does not protect against marsh fevers, nor 
vice versa. 

" The acclimation of negroes, even, according to my observa- 
tion, has been put in too strong a light. Being originally 
natives of hot climates, they require no acclimation to tempera- 
ture, are less liable to the more inflammatory forms of malarial 
fevers, and suffer infinitely less than whites from yellow fever: 
they never, however, as far as my observation extends, become 
proof against intermittents and their sequelae. The cotton 
planters throughout the South will bear witness, that, wherever 
the whites are attacked with intermittents, the blacks are also 



24 Indigenous Races. [January, 

susceptible, though not in so great a degree. My observations 
apply to the region of country removed from the rice country. 
We shall see, further on, that the negroes of the rice-field region 
do undergo a higher degree of acclimation than those of the 
hilly lands of the interior. I know many plantations in the 
interior of Alabama, South Carolina, Georgia, Mississippi, and 
Louisiana, on which negroes of the second and third generation 
continue to suffer from these malarial diseases, and where gangs 
of negroes do not increase." (p. 376.) 

And again : "Certainly, negroes do suffer greatly on many 
cotton plantations in the middle belt of the Southern States ; 
and I have seen no evidence to prove that negroes can, in this 
region, become accustomed to the marsh poison ; and my observ- 
ation has been extensive in four States. A question here arises: 
Is there any difference in types of those malarial fevers which 
originate in the flat tide-water rice-lands, and those of the clay- 
hills, or marsh fevers of the interior? I am inclined to think 
there is." (p. 381.) 

Having already extended this notice of Dr. Nott's able and 
interesting paper, beyond the limits we had intended, we must 
bring it to a close, by adding the author's conclusions. 

" 1. That the earth is naturally divided into zoological realms 
— each possessing a climate, Fauna, and Flora, exclusively its 
own. 

" 2. That the Fauna of each realm originated in that realm, 
and that it has no consanguinity with other Faunas. 

" 3. That each realm possesses a group of human races, which, 
though not identical in physical and intellectual characters, are 
closely allied with one another, and are disconnected from all 
other races. We may cite, as examples, the white races of Eu- 
rope, the Mongols of Asia, the blacks of Africa, and the aborig- 
ines of America. 

" 4. That the types of man, belonging to these realms, ante- 
date all human records, by thousands of years ; and are as 
ancient as the Faunas of which each forms an orginal element. 

" 5. That the types of man are separated by specific charac- 
ters, as well marked and as permanent as those which designate 
the species of other genera. 

" 6. That the climates of the earth may be divided into phys- 
ical and medical; and that each species of man, having its own' 
physiological and pathological laws, is peculiarly affected by 
both climates. 

" 7. That no race of man can be regarded as cosmopolite ; but 
that those races which are indigenous to latitudes intermediate 



1858.] On Scarlatina. 25 

between the equator and poles, approach nearer to cosmopolit- 
ism than those of the Arctic or the Torrid Zone. 

" 8. That the assertion, that any one race ever has, or ever 
can be, assimilated to all physical or all medical climates, is a 
hypothesis unsustained by a siDgle historical fact, and opposed 
to the teachings of natural history." (p. 401.) D. 



On Scarlatina. A Clinical Lecture delivered in Paris, by M. 
Trousseau. (Translated from the Gaz. Hebdomadaire.) Con- 
cluded from page 730, vol. xiii. 

We have now come to a more difficult part of the question — 
to the consideration of that which I have called latent (fruste) 
scarlatina. 

You know what is meant in archaeology by a latent (fruste) in- 
scription; that a greater or less part of it is wanting, a line, a 
letter, a point even only remaining. In speaking of pneumonia, 
we have seen that that disease could be latent, that often there 
was only a word in the symptomatological phrase, and that from 
this word alone the physician should find out the whole phrase. It 
is with the physician as with the numismatist and archaeologist. 
At the commencement of their studies these have to read from 
well preserved medals, from stones intact, while the student of 
medicine requires that all the symptoms which usually character- 
ize a disease should be found in a case which falls under his ob- 
servation. After a while, however, the archaeologist only requires 
a word, a letter, to be enabled to decipher the effaced inscription. 
So it is with the more experienced physician ; he divines from a 
single symptom of a disease the whole disease. Of all the latent 
diseases, scarlatina presents these desiderata the oftenest. 

In 1829, one of my friends told me that scarlatina prevailed in 
a little village near Mennecy, in the department of Seine-et-Oise, 
and principally in the communes of the Chateau de Villeroy. 
Wishing to study this epidemic, I could do it more easily from 
the fact that as the chateau was perfectly isolated, the evolutions 
of the disease could be easily followed. 

I saw individuals of the same family affected with sore throat, 
without eruption, and although they remained in the midst of 
those who were afterwards attacked with scarlatina, these persons 
escaped. Their sore throat was violent, accompanied with high 
fever, redness, and desquamation of the tongue. Others, who 
were attacked lightly, being slightly unwell for eight or ten days, 
sudenly became swollen, and passed blood. Albuminuria was 
not known at that period. These facts struck me, and caused 



26 On Scarlatina. [January, 

me to think these persons having, some of them the eruption and 
consecutive anasarca, others the anasarca of sore throat only, 
were differently attacked, but that all had the symptoms of scar- 
latina. 

Three years since at Meaux, an analogous fact came under 
my observation, occurring in the same house. A young girl, 
fourteen years old, was taken with a violent scarlatina, character- 
ized by croupal angina, the eruption, and an intense fever. A 
few days afterwards, her sister was also taken sick with the same 
symptom ; almost at the same time a chambermaid fell sick ; two 
or three days after, a man-servant, who staid in the room the 
whole day, was affected with a severe sore throat, with croupal 
exudations on the tonsils, redness and exfoliation of the tongue, 
high fever, but without cutaneous eruptions. It was clear to me, 
as the physician of the family, M. Saint Armand, also thought, 
that all these patients had scarlatina, and in fact the man-servant, 
although remaining in the midst of the epidemic locality, did not 
take the disease with which he had been inoculated in the same 
degree as the rest of the family ; while the scarlatinous phase was 
complete in the others, in him the inscription was latent (fruste). 
There still remained a young boy, six years old. Suddenly, with- 
out having been sick a single instant, he became swollen. M. 
Blache and myself were called in consultation, and we recog- 
nized the anasarca of scarlatina presenting itself at the outset; it 
was considerable, and accompanied with haematuria. The father 
and mother, who were very attentive to the health of their son, 
declared that in the morning he had breakfasted as usual. This 
child had neither fever nor eruption, and the disease manifested 
itself in time, by the single symptom which we have indicated. 
Eight days afterwards he had a double pleurisy, and came near 
dying. Called again in consultation, M. Blache and I recognized 
this affection ; four days after, we found one of the sides of the 
chest cured, while the other had taken on an enormous develop- 
ment. We performed paracentesis of the chest, and drew off one 
pound and a half of pus. During two to three months, Dr. Saint 
Armand made iodine injections into the pleura; notwithstanding 
a pulmonary perforation, the child recovered, and is now in good 
health. 

I have not myself had any cases like these. Graves cited sev- 
eral, a few of which I shall translate for you. 

"Young F was taken home from school when scarlatina 

prevailed. He complained of sore throat upon swallowing, head- 
ache, nausea. The next day the tonsils were swollen, and he 
experienced a greater difficulty in swallowing. His pulse was 
quick,' — skin hot, but no traces of eruption. These symptoms 
continued three days without increasing in severity, and then dis- 
appeared. Before he entirely recovered his two sisters and his 



1858.] On Scarlatina. 27 

father were attacked. The eruption appeared upon the skin in 
his two sisters, and ended in desquamation, while in his father 
there were only a few red points upon his skin, without ulterior 
desquamation." 

"Master O also returned from school with scarlatina. 

During his sickness his two sisters and his brother were taken 
with the same disease. In all these it manifested itself under the 
form of small eruptions, or maculae, upon the skin. At the same 
time the man-servant and maid-servant suffered from violent an- 
gina, with high fever, which lasted several days." 

These facts are identical with those I have myself seen. In 
the following, which occurred in the family of a physician, you 
will observe that the disease developed itself by anasarca : 

" The following case," says Graves, u was communicated to me 
by a very eminent practitioner of Dublin. A few years since 
scarlatina broke out in the family of this physician, and attacked 
all the children, with the exception of a young lady who, although 
taking care of her sisters during their sickness, had no symptom 
of it. When they were convalescing, the family was sent into 
the country for the sake of the change of air, ihe sister who had 
not been sick accompanying them. There, to their great aston- 
ishment, she was suddenly taken with that peculiar anasarca 
which is observed in those who have had scarlatina. Her father, 
who took care of her during this sickness, was struck with this 
singular fact : he paid particular attention to it, and became con- 
vinced that it was a latent scarlatina." 

" These cases, and those of which I have already spoken," con- 
tinues Graves, "are very interesting in a pathological point of 
view ; they tend to prove this fact, that, in many circumstances, 
diseases produced by contagion do not present the same series of 
symptoms which ordinarily characterize them." 

These extracts from the English author prove that the same 
things occur in Dublin as in Paris. It is very certain that you 
will see these latent scarlatinas ; you cannot, therefore, become 
too familiarly acquainted with them. Graves insists upon these 
facts as a means of demonstration, and he positively indicates 
that these are cases of scarlatina ; for, says he, the disease being 
essentially contagious, it would be impossible that those who only 
had the sore throat or the anasarca should be alone exempt in the 
midst of their family sick with scarlatina, which had attacked all 
the rest. 

Treatment. — The eruptive diseases, whether the eruption 
takes place on the skin or upon the internal viscera, as is the case 
in putrid or typhoid fever, which is an eruptive disease of the di- 
gestive tube, the eruptive diseases have a fatal course ; that is to 
say, they have determined phenomena against which we cannot 
n.s. — vol. xrv. no. i. 2 



28 On Scarlatina. [January, 

cope with success. In the treatment of these diseases, the physi- 
cian should not forget this grand fundamental fact ; that whatever 
may be said, he cannot prevent the progress of a putrid fever, nor 
can he cut short a case of variola or rubeola. Doubtless, unskil- 
ful attention can retard or modify, in a certain manner, the ap- 
pearance of the eruptions ; but whatever means may be employed, 
art is powerless against the evolution of an exanthematous fever, 
whatever it may be. In these diseases, more than any other, the 
physician should be minister natural et interpres ; for in these dis- 
eases, more than any other, quicquid meditetur etfaciat,. si natural 
non obteinperat natural non imperat; his duty, when everything 
progresses regularly, should be essentially passive, otiosus crisium 
spectator, as Fizer said ; if no severe symptom arises, he has only 
to fold his arms; in a few days the disease will have accomplish- 
ed its evolution naturally. 

When the eruptive fevers become in some particulars men- 
acing, our intervention, let us avow it, is generally of little avail. 
In some circumstances, however, we can be useful. These for- 
tunate circumstances in which art interferes efficaciously, are 
more frequently met with in scarlatina and rubeola than in vario- 
la and putrid fever. 

I shall show you what the physician can do in the first of these 
diseases. Above all, it is well to recollect that scarlatina varies 
greatly in its form and severity ; that sometimes it is of an extra- 
ordinary mildness, sometimes, on the contrary, its malignancy 
renders it a terrible disease, the equal of the plague and typhus. 
This should be taken into account, for success should not be 
attributed to the medication which he may have used, the honor 
of which belongs entirely to the benignity of the epidemic itself; 
nor should his failures be laid to the treatment w T hich could not 
prevail against the essentially malignant nature of the disease. 

Epidemics can be generally severe for a whole population ; 
they can also be severe for a single family. The malignancy can 
be circumscribed, so to say, within a small compass ; but in these 
cases, it is malignant for almost all those it attacks within the cir- 
cle to which it is confined. In this connection I will recall to 
your recollection the sad fact, published lately in the English 
journals, of scarlatina carrying off, in one week, six or seven 
children of a clergyman of York. 

It seems that the poison with which those attacked with scar- 
latina are infected, has a particular activity, or that the constitu- 
tion of each of the patients is disposed in a special manner for 
receiving it. Whether the malignancy depends upon the nature 
of the disease, upon its epidemic character, as Sydenham and 
others say, — whether it depends upon the particular constitution 
of the individuals, according to the opinion of Stoll, this grand 
fact always remains, namely : that when scarlatina breaks out in 



1858.] On Scarlatina. 29 

a family, with its terrible phenomena, destroying the first it at- 
tacks, it is well to mistrust and fear it, for it will probably take 
off other victims ; and also when its first severity has moderated, — 
when it appears from the start benign, it is well to hope, for gen- 
erally it will remain benign. 

This should be said before entering upon the study of the treat' 
ment, in order to put you upon your guard against yourselves. I 
cannot repeat it too often that, if the disease is in itself severe, 
the best medication will most frequently fail ; if it is in itself be- 
nign, recovery will most usually result, and the most inappropriate 
medication will not be injurious. 

There is a point upon which all epidemiographists agree ; it is, 
that the antiphlogistic treatment, bleeding, too energetic purgatives, 
and rigorous diet, are pernicious. There is not, perhaps, an au- 
thor, — I speak of those who have followed, studied, and described 
many successive epidemics, — who has not established the danger 
of this treatment in severe scarlatina, and even when, in the pnv 
gress of this disease, acute inflammatory phenomena arise, such 
as phlegmons of the tonsils, of the lymphatic ganglions, of the 
cellular tissue, that bleeding and leeches do not generally succeed, 
probably because they are directed to symptoms of a septic dis- 
ease, — of a disease of a bad character, mali maris, — one of those 
malignant diseases in which the antiphlogistic treatment is always 
invariably injurious. 

Still these epidemiographists, in giving the sad results of their 
experience, — in condemning the antiphlogistic means of which 
they have observed the bad results, — these epidemiographists' teach 
you that, if the energetic purgatives are hurtful, the milder mer- 
curials, the neutral salts, given in a proper proportion, are of real 
utility. They say that, under the influence of laxatives which 
produce two or three passages a day, the febrile movement will 
be most usually moderated. However, they are far from pretend- 
ing that the disease is always cured by these means. 

We have seen that, in Scarlatina, and particularly when at its' 
height, patients seem to succumb to a nervous exaltation, at least 
to nervous disturbances, arising either in the centres of organic 
life, characterized by an extra ordinary elevation of the tempera- 
ture, vomiting, obstinate diarrhoea, or in the centres of animal 
life, manifested by delirium, coma vigil, subsultus tendinum, and 
convulsions. For these nervous symptoms there is a treatment, the 
value of which has been proved by experience, — a treatment 
which the physician adopts, however, with great caution. I speak 
of the cold affusions extolled by Currie. 

Currie was the first to recommend their use. He treated a 
large number of patients afflicted with the severe form of scarla- 
tina, and had considerable success from the use of cold affusions. 
Emboldened by his fortunate results, he insisted upon this mod© 



30 On Scarlatina. [January, 

of treatment, and established its application as a general rule in 
scarlatina accompanied with severe nervous symptoms, such as 
delirium, convulsions, diarrhoea, excessive vomiting, and a high 
temperature of the skin. 

How should this treatment be applied? The patient placed 
naked in an empty bath-tub, three or four pails of water, at a 
temperature of 20° centigrade (68° Fahrenheit) are thrown over 
his body. This affusion lasts from a quarter of a minute to a 
minute, at the longest. The patient is immediately enveloped in 
blankets, placed in bed without being w T iped off, and properly 
covered ; reaction generally follows in fifteen or twenty minutes. 
The allusions are repeated once or twice in the twenty-four 
hours, according to the severity of the symptoms. They should 
be administered at that moment when the nervous phenomena 
assume such an intensity as to excite our fears of imminent dan- 
ger; they are to be repeated until these symptoms cease, relieving 
the mind of the physician from further cause of alarm. 

To suggest in private practice a treatment apparently so bold, 
one would have to have grown old in practice, to be beyond the 
necessity of being sustained by public opinion. He should be 
fortified by a deep sense of duty — by a consciousness of doing 
well, in order to strive successfully against the popular prejudice, — 
of all prejudices perhaps the most unfortunate, — which demands 
that, in eruptive fevers, patients should have warm drinks and be 
wrapped in more coverings than they are accustomed to in health. 
There is no prejudice, we say, which is more unfortunate than 
this ; there is none which more frequently occasions the death of 
the patient. Yet the voice of Sydenham, which has spoken for 
two hundred years, — the authority of the most distinguished phy- 
sicians who still object to it, resist in vain. 

You understand, then, the difficulties which the young physi- 
cian will have to encounter who believes he should have recourse 
to these cold affusions. These difficulties are the greater because 
it is in the severe cases, where the scarlatina threatens to be fatal, 
that the indications of this treatment are found. In adopting this 
treatment, you know that the disease gives one chance of recove- 
ry to two of death, and you can foresee, if you are not successful, 
what will be the opinion of the family afflicted with the loss they 
have sustained. 

I have employed these affusions for a long time. I tried them 
in private practice before adopting them in hospital practice, for 
I have never made use of anything there which I had not previ- 
ously tried in my private practice. As to these cold affusions, I 
can assure you that I have never used them without gaining 
some beneficial effect from them. I do not pretend to say that 
all my patients were cured. Far from it. I have lost a great 
many, but they died notwithstanding the treatment. The affu- 



1858.] On Scarlatina. 31 

sions, instead of being injurious, seemed to moderate the symp- 
toms and retard the fatal termination. By acting in this way in 
private practice, my reputation ran great risks, and I have been 
often badly recompensed for doing what my profound conviction 
dictated; but I remained firm in my course which duty marked 
out for me, and I persist in it up to this hour, for a stronger rea- 
son than formerly ; for now, my position being established, my 
responsibility does not influence me as much. I understand your 
fears — not that you doubt the advantages of the treatment which 
you dare not adopt, but because, while consulting before all the 
interest of the sick entrusted to your care, you yet have to watch 
over your own reputation, which is so easily affected at the com- 
mencement of your career as practitioners. Still, when the voice 
of duty speaks to you, when your conscience tells you that this 
treatment you dare not adopt because it is contrary to the preju- 
dices of the world, is a useful treatment, it is still necessary to try 
it, it is right that you should do it. But then, instead of resisting 
this prejudice face to face, instead of taking the bull by the 
horns — if you will pardon me this vulgar expression — avoid the 
difficulty, by administering these useful cold affusions, leaving the 
patient, and especially the attendants, in the belief that the affu- 
sions are warm. 

Scarlatina, as I have already said, especially in its malignant 
form, has, of all diseases, the highest elevation of the temperature 
of the body. In some cases. I have also told you. it is as high as 
106° Fahrenheit, consequently about six degrees above the normal 
temperature. Now, do not make use of the affusion, but of sim- 
ple lotions, and with water at seventy-seven degrees Fahrenheit, 
that is, 29° less than the temperature of the skin of the patient; 
relatively it is cold. Put the patient upon a cot-bedstead and 
sponge the body with this water, first in front and then behind, and 
then replace him in his bed, wrapped in blankets, as I have already 
indicated. Although less efficacious than cold affusions, this kind 
of affusion has a positive effect, and following its application, you 
will perceive that the skin, which was before very dry and ex- 
tremely hot, will become in half an hour cooler and moist. What 
is still more remarkable, is the diminution in the frequency of the 
pulse. Instead of beating in the infant 160, 170, 180 ; in the 
adult 140, 150 ; it falls to 130, 135, 140, in the former; to 120, 
115, in the latter; consequently, 30, 35, 40, pulsations less. At 
the same time the cerebro-spinal phenomena diminish in intensi- 
ty, the vomiting and excessive diarrha?a, symptoms depending 
upon disturbances of ganglionary innervation, also diminish. 
Thanks to these lotions, then, you obtain, for a short time I grant, 
a remarkable sedation. I say for a short time, for in two or "three 
hours the symptoms sometimes return, when the lotions, or affusions, 
should also be repeated two, three, or four times in the twenty-four 
hours, and sometimes five or six days in succession. 



32 On Scarlatina. [January, 

What becomes of the eruption ? You will observe this fact, 
which will surprise the assistants and reconcile the family to the 
'lotions, the affusions which they mistrusted; that, almost invaria- 
bly, from the beginning of the affusion, the skin, which was pale, 
or of a faint red color, becomes more developed. These affusions, 
therefore, not only do not decrease the eruption, but bring it out, 
so that the parents themselves notice it, and as long as danger 
continues, they are often the first to solicit its employment, 
unable to refuse to recognize the amelioration which this 
method of treatment has produced, particulary struck with the 
fact that the eruption reappeared more distinct. Yet, in verity, 
if the result of this amelioration is not favorable, if death takes 
place, they forget the encouragement they gave you, they accuse 
you of the misfortune which can only be attributed to the char- 
arter of the disease. 

To meet these terrible symptoms of scarlatina, other internal 
remedies can be administered with advantage. And first, the am- 
moniacals, the carbonate of ammonia, spirits of mindereri, which 
is an acetate ammonia, mixed with some empyreumatic products ; 
these two medicaments in the dose of \ a drachm to 1 drachm, 
— ammonia itself in the dose of 10 to 20 drops, — can be very 
useful. I shall say as much of musk, of which 3, 4J, 6 grains, 
and even 15 grains, is given in the course of twenty-four hours. 
These means should be used with prudence; they constitute an 
accessory treatment in those cases where the cold affusions are 
employed ; when they are not employed, they comprise the prin- 
cipal therapeutical means. 

The angina of scarlatina, which is accompanied with croupy 
exudations, when they are not very abundant, is not very dan- 
gerous. But in malignant scarlatina the disease attacks the 
throat, and generally the physician cannot prevent it. 

I have tried cauterizations with nitrate of silver, with chlorohy- 
dric acid; I have tried borax in collutories; I have given 
chlorate of potassa within, and I must say that all these remedies 
have very often failed in my hands. However, of all these thera- 
peutic agents, the most to be depended upon, chlorohydric acid, 
applied twice a day, has seemed to be of some use. This caustic 
is to be used with great prudence and precaution. In children, 
during the stuggle to overcome their resistance, you may burn . 
the tongue, the teeth, the internal walls of the mouth, and thus 
increase the evil without cauterizing as it should be done. By 
holding the child properly, and opening his mouth by means of a 
spatula, you can sometimes obtain good results from these cauter- 
izations, touching the diseased parts twice a day, for five or six 
days, with a camel's hair pencil saturated in the acid. Insuffla- 
tions of alum and tannin, used alternately, are also very useful. 
As to that form of angina which is not observed during the height 



1858.] On Scarlatina. 33 

of the disease, but comes on suddenly about the ninth or tenth 
day, with an abundant exudation from the nose, with deafness, 
or severe pain in the ears, foetid breath, frequent pulse, and great 
depression, as to that angina which is probably only a diphtheri- 
tic complication of scarlatina, it resists all our efforts. All kinds 
of treatment which I have tried have failed — nasal injection with 
styptics, with the solutions of sulphate of copper, of sulphate of 
zinc, nitrate of silver, with the decoction of rhatany, with tannin, 
the cauterizations of the throat — all have failed ; patients almost 
invariably succumbing, whatever you do. In these cases you must 
Tely upon generous treatment, upon sulphate of quinine, coffee, 
and especially upon a strengthening alimentation. 

And now of the anasarca of scarlatina and the symptoms 
which complicate it. I have already stated that it follows less 
frequently the severe forms than the benign eruptions. Often it 
constitutes a complication of the greatest importance, in other 
cases this complication is not serious. When it is slight, I have 
also said that hygienic means, rest in bed, lukewarm drinks, a 
moderate diet, is all that is necessary. When, however, the urine 
contains blood, acid drinks, lemonade, the decoction of uva ursi, 
sweetened with the syrup of turpentine, small quantities of digita- 
lis, mild laxatives, will meet these symptoms. But when the 
haemorrhage is quite large from the commencement, when the 
anasarea increases with great rapidity, it will be necessary to 
resort to other means to prevent the threatning symptoms. 

Sulphuric acid given internally either pure or in alcohol (eau 
de rabel), in the dose of \ a drachm to \\ drachms a day, in a 
draught sweetened with syrup of rhatany, will be found useful 
when the haemorrhage is abundant. 

The anasarca which comes on rapidly and in a great degree, 
is ordinarily accompanied with convulsions, which sometimes 
destroy the patient with the first attack. Energetic purgatives 
are, in these cases, useful, by causing a part of the serum effused 
into the celular tissue to be thrown out upon the surface of the 
intestine. It is also important to place the lower limbs of the 
patient hanging over the side of the bed, and the head raised by 
pillows. By this means imminent convulsions may be prevented. 
But in some cases these convulsions are present from the begin- 
ning, coming on without giving warning of their approach. The 
patient complains of a severe headache, difficulty in the sight, 
upon one side alone or both together, sometimes ringing in the 
ears and deafness. In these cases, scarifications of the inferior 
extremities may be of advantage. What is sometimes better, in 
attaining the same result, is the application of very large blisters 
upon the legs, and not upon the thighs. After seven or eight 
hours, phlyctenne will be formed, and when they are opened 
serum will flow abundantly from them, relieving the patient, and 
enabling him to pass the crisis of his anasarea. 



31 On Scarlatina. [January, 

If the convulsion takes place, give, during the attack, mush in 
connection with small doses of belladonna. For a child eight or 
ten years old, musk, in the dose of from 3, 4£, or 6 grains ; bella- 
donna in that of one-tenth of a grain for a single dose. At the 
same time you should make use of a means I have employed 
for more than twenty years, and from which I, as well as other 
physicians, have experienced great service : I speak of the com- 
pression of the carotids. This compression requires to be carefully 
made, and in a certain manner. When the epileptiform convul- 
sion predominates upon one side, the compression should be 
exercised upon the opposite side. If, then, the convulsion be 
predominant upon the right side, it is the left carotid which should 
be compressed, and reciprocally if the convulsion be predominant 
upon the left side the right carotid should be compressed. If the 
convulsion be equilateral the compression should be alternately 
produced upon the two carotids, — I speak, be it well understood 
of the primitive carotids — and even simultaneously upon both, 
if it is possible to do so without interfering too much with the 
respiration of the child. 

This compression is easier to perform than you would suppose. 
Place yourself so that the right hand can compress the left 
carotid, and the left hand the right carotid ; push aside the sterno- 
cleidomastoid muscle, while with the back of the ungual phalanx 
you push aside the trachea, and you will feel the beatings of the 
carotids. Seizing it, then, from within with the ends of the 
fingers, carry it backwards a little and press it against the verte- 
bral column. You will instantly perceive that it is compressed, 
by the absence of pulsation in the corresponding temporal artery, 
by the paleness which sometimes suddenly succeeds to the previ- 
ous redness of the child's face, and again by the fact that in some 
fortunate cases the compression is no sooner established than the 
eclamptic convulsion ceases. Continue this compression upon 
one of the arteries for fifteen to twenty minutes, then compress 
the other. If you have an aid that can assist you, his assistance 
will be useful to you in this operation; the mother, whose solicitude 
renders her so intelligent, can replace you. By this means, having 
patience, the convulsions accompanying the anasarea of scarlatina 
can be arrested, in a certain number of cases, in a few hours. 

There still remains that form of anasarea which if it becomes 
chronic, can be relieved. When the convulsions, which are so 
often mortal, have ceased ; when the hematuria, which precedes 
or accompanies the anasarca has passed, give the patients diure- 
tics, nitrate of potassa principally, in connection with small doses 
of digitalis, give also a remedy prescribed by Graves, the iodide 
of potassium in large doses. 

In some cases the anasarca and the albuminuria, which are 
ordinarily cured in fifteen days, three weeks or a month, can be- 



ISoS.] Artificial Rupture of the Amniotic Sac. 35 

come the commencement of Bright's disease. The acute symp- 
toms disappear, the albuminuria persists ; if it persists a month 
or six weeks after scarlatina, beware of this symptom: it indi- 
cates the commencement of Bright's disease ; the kidney is infil- 
trated with fibroplastic tissue, after six weeks the fatty element 
predominates, and a few months later the patient succumbs to 
this new afFection. 

Finally, there are a few more serious symptoms which are 
developed in this last period of scarlatina about the same time as 
anasarca. They are the serous effusions of the pleura and peri- 
cardium. 

For these the repeated applications of fly-blisters, and if the 
hydrothorax or the hydro-pericarditis is very great, puncture 
may be useful. 

In large pleural effusions, thoracentesis sometimes becomes 
necessary after a very few days. But often, as I have already 
observed, with the first puncture, even when the effusion has not 
existed more than ten. fifteen, or twenty days, you will find a lactes- 
cent serum, sometimes pus, already formed. Then you have 
empyema, a formidable complication, which you can frequently 
cure in young persons by puncture, and repeated iodine injec- 
tions ; but which, in adults, notwithstanding these means, you 
will rarely cure. — [American Med. Monthly. 



Artificial Rupture of the Amniotic Sac during Labor. — Objections 
to the Practice. By B. F. Richardson, M. D., Adjunct Pro- 
fessor of Obstetrics and Diseases of Women and Children, in 
the Medical College of Ohio. 

[The above being a subject of much interest, we present to our 
readers Dr. Richardson's second paper, from the Western Lancet^ 

In the last number of this Journal, quotations were made from 
numerous standard obstetrical authorities, which, directiy and 
by fair implication embody the doctrine, that the amniotic sac is 
the only proper and efficient agent in the production of dilatation 
of the os uteri ; that after it is well dilated, or dilatable, there 
remain no important objections to rupturing the membranes ; 
and that, therefore, it is undesirable to maintain the integrity of 
the amniotic sac beyond that period. At the conclusion of that 
article we promised to show, " that one of its most important 
- remains unfulfilled until the presenting part has passed 
through the superior strait ; and that in all natural, uncomplica- 
ted labors, especially primipera, the membranes should not be 
ruptured at any time." 

If this proposition can be sustained by argument and numer- 



36 Artificial Rupture of the Amniotic Sac. [January, 

ous facts, the inference is patent, that the views entertained and 
inculcated by obstetrical writers generally, in regard to the office 
and treatment of the amniotic sac, are well calculated to serious- 
ly mislead those who exercise their memory more than their 
reason. He who conceives of no objection to the rupturing of 
the membranes after the os uteri is well dilated, will, almost 
certainly, rupture them, in expectation of exciting more vigor- 
ous uterine contractions. 

Perhaps, on no other point connected with obstetrics has there 
been so much misinterpretation of facts, assumptive reasoning, 
and erroneous conclusions, on the part of writers, as in regard to 
the mechanism and phenomena of the first stage of labor. As 
the views entertained by Professor Murphy on this point are in 
accordance with those of most writers, and as he has elaborated 
the argument through which these views have generally been 
derived, a review of his positions will be appropriate, in the 
course of my remarks. 

Is the amniotic sac the only proper and efficient agent in the pro- 
duction of dilatation of the os uteri ? 

Are there any important objections to rupturing the membranes 
after complete dilatation of the os uteri has taken place f 

The discussion of these questions will embody the answer to 
the first : Is it desirable to maintain the integrity of the amniotic sac 
during labor? 

Prof. DeweeSj by an ingenious argument, attempts to show 
that, ordinarily, the amniotic sac has nothing to do in the pro- 
duction of dilatation ; but unfortunately he admits, in part, that 
which he undertakes to disprove ; and moreover is guilty of 
palpable inconsistency. At the conclusion of paragraph 515, he 
writes: " but in this admission, let it be recollected that I con- 
sider the waters as useful by their equal pressure upon the lower 
part of the uterus, and by distending, and at the same time, by 
the same agency, weakening, the circular fibres of the part, and 
thus indirectly favoring the dilatation of the mouth of the ute- 
rus." Now turn to paragraph 518. " When the os uteri does 
dilate, it is not by its edges being stretched mechanically ; it is 
an absolute inability in the circular fibres to maintain a state of 
contraction, and, for the time being, may be considered as par- 
alyzed ; or excessively fatigued; or, perhaps, more properly 
speaking, it is the relaxation of a sphincter not subject to the 
control of the will." Where a proposition is faulty, the reason- 
ing is apt to be illogical. This gifted and lamented author was 
endowed with a spirit of controversy to an extent that some- 
times led him into the adoption and support of views, which his 
acknowledged powers of argumentation were insufficient to 
sustain. However, in attempting to exclude entirely, the amni- 
otic sac as a usual participant in the dilatation of the os uteri, 



1858.] Artificial Rupture of the Amniotic Sac. 37 

he assumed a task perhaps not more difficult than that of Prof. 
Murphy, who undertakes to demonstrate that it is the only pro- 
per and efficient dilating agent. 

We have heretofore stated that the argument and assumptions 
of Prof. Murphy involve "a total disregard of well known hy- 
drostatic and mechanical laws ; and that he takes the position 
" that the amniotic sac is a better dilator of the os, than the 
smooth, round, and comparatively unyielding vertex." At page 
55, commenting upon the argument of Dewees, he remarks : 
" It would make the membranes not only useless as a means of 
dilatation, but rather a difficulty in its accomplishment. The 
head of the child, directly applied to the cervix, would over- 
come the resistance of the circular fibres much more efficiently 
than the liquor amnii, so that the most favorable kind of dilata- 
tion would be that which occurs when the membranes are rup- 
tured at the commencement of labor. It is very well known 
that this does not happen ;" and after giving Dewees' explana- 
tion of the difficulty, proceeds : " But in place of the waters, there 
is the large, round, and unyielding head of the child forced down 
upon the lower part of the uterus, which one would suppose 
more efficient for the purposes of mechanical distension." — Ac- 
cording to the opinion of Dewees, and not his own, as we may 
fairly infer. Again, at page 50, "If the uterus exerted its fuU 
power upon the un dilated os uteri, and if the unyielding head 
of the child were driven forcibly against it, the almost certain 
consequence would be, that the irritation would excite increased 
resistance, and ultimately terminate in inflammation of the 
mouth of the uterus. To obviate such an effect, nature interpo- 
ses a fluid medium between the power and the resistance. The 
liquor amnii contained within the membranes, occupies the 
cavity of the uterus, and when its parietes contract upon it, the 
force exerted is (as we have explained) by this means, accurate- 
ly conveyed to the os uteri. When the latter dilates in the 
slightest degree, the fluid insinuates itself within the smallest 
opening, and expands it by a direct lateral pressure against its 
edges. The power of the uterus is thus made to act in the most 
favorable manner for distending its mouth." 

On same page, he says: " Further, so long as the tissue of the 
uterus intervenes, it is necessary to moderate the great power 
which the uterus is capable of exericising to dilate it : this is 
effected by the liquor amnii." Again, on page 108 : " The gra- 
dual escape of the liguor amnii also gives rise to tediousness. If 
this take place when the os uteri is slightly dilated, in other 
words, when the latter is so long exposed to the pressure of the 
head of the child as to become irritated by it, the result is rigidi- 
ty of the os uteri, etc." On page 55 we also read: " If they are 
ruptured when the dilatation is very slight, the suddenly in- 



38 Artificial Rupture of the Amniotic Sac. [January, 

creased power of the fundus, forcing the head of the child against 
the os tineas, soon excites irritation, prevents its expansion, and 
sometimes causes inflammation. But if they are broken when 
the uterus is sufficiently open to allow the membranes to protrude 
into the vagina, and the contractions of the fundus to increase, 
it is probable that the dilatation will be advanced more rapidly, 
etc." This last quotation contains its own refutation. I have 
been thus copious in my citations, for the reason, that they em- 
body the views of all authors within my knowledge, Dewees 
excepted. 

Now, what inferences are fairly deducible from the foregoing 
quotations ? I shall state and answer them as I proceed : First- 
ly, the amniotic sac is the essential agent in the production of dila- 
tation of the os uteri, producing it u by a direct lateral pressure 
against its edges." The fact, that in a fair proportion of multi- 
paras labors, the uterine orifice opens readily and to some con- 
siderable extent, before either the head or membranes have 
engaged within it, is fatal to this theory. Further, it is a well 
known fact to those who have made careful observation, that 
occasionally in multiparas labors, where, from fragility of the 
membranes, the liquor amnii has been evacuated early, and be- 
fore the head has descended sufficiently to press upon the os ; 
enlargement of the orifice proceeds without interruption. 

There are three agencies concerned in the production of dila- 
tation. Firstly: and essentially, contraction of the cervico- 
fundal fibres acting upon the circle of the os uteri through their 
free extremities. Secondly, a body (the amniotic sac or presen- 
ting part) over which to retract the border of the os ; and, Third- 
ly : pressure by descent of the amniotic sac, or presenting portion 
of the foetus. 

Secondly : The amniotic sac is a more efficient dilating agent 
than the vertex, for the reason, that the force exerted by the uterine 
contractions is " accurately conveyed to the os uteri'" tuhereas the 
same force transmitted through the vertex, would " soon irritate" the 
os, and " prevent its expansion." Here we have groundless as- 
sumption, misinterpretation of facts, and erroneous conclusions. 
By what law of mechanics does a yielding body like the am- 
niotic sac, become a more efficient mechanical dilator than a 
solid body like the vertex ? If the force of the contractions is 
(as is asserted) accurately conveyed to the edges of the os uteri, — 
the membranes being non-distensible, and therefore unable to 
absorb any of the force — why is the amniotic sac incapable of 
irritating and inflaming the os and arresting its dilatation, no 
matter how great the power exerted by the uterine walls ? Can 
the vertex do more than transmit this force to the edges of the 
os uteri ? 

Again, it is assumed that the whole force of the uterine con- 



1858.] Artificial Rupture of the Amniotic Sac. 39 

tractions is accurately conveyed by the amniotic liquor to the 
edges of the os uteri, as soon as the latter is opened in the 
" slightest degree." Now, the exact measure of force which the 
liquor amnii is capable of conveying to the edges of the os uteri, 
is determined by the force which the "unsupported membranes at 
the orifice are capable of sustaining. Who can suppose for a 
moment, that these frail membranes can support the whole 
power generated by vigorous uterine contraction ? Let us take 
even Prof. Murphy's own statement, when combatting the argu- 
ment of Dewees, in regard to the antagonism of the circular and 
longitudinal fibres : " but how the membranes could resist the 
effect of this struggle it would be difficult to understand, when 
we know that change of position, walking across the room, or 
other such trifling causes, are sometimes sufficient to rupture 
them, from the gravitation of the fluid alone, and therefore the 
greater force arises from the action of the fibres of the uterus 
against each other, must break them more frequently than what 
we know to be the case." Prof. Murphy therefore supposes, that 
antagonism between the vertical and transverse fibres, imparts 
to the liquor arnnii, greater force, than when they contract con- 
jointly. Such a view evinces a defective knowledge of hydros- 
tatic laws. The simultaneous contraction of all the uterine 
fibres, will distend the membranes at the orifice more forcibly 
than any partial contraction possibly can. 

Further, it is assumed, that when the amniotic sac is prema- 
turely ruptured, it is replaced by the vertex, which transmits 
the power of the uterine contractions to the os uteri, thereby 
irritating, and rendering it rigid and unyielding ; and the con- 
clusion is, that the tediousness of delivery, and apparent change 
in the condition of the os uteri, which usually attend this acci- 
dent, are attributable to the alleged fact, that the vertex is in- 
capable of dilating the os as efficiently as the amniotic sac. I 
have dwelt at length on this point, as the most important con- 
nected with our discussion ; and an exposition of the mechan- 
ism and phenomena of the first stage of a primiperoa labor, will, 
I think, show wherein obstetrical writers have been led into 
fallacious reasoning, and false conclusions, by the oversight and 
misinterpretation of facts. At the commencement of labor, and 
before the os uteri begins to open ; we find the child occupying 
the uterine cavity, with its pelvic extremity in contact with the 
fundus, and its head resting upon the pelvic brim, presenting 
the occipitofrontal diameter more or less modified, — the liquor 
amnii filling up the inequalities. As the contractions continue, 
the liquor amnii is displaced in that direction in which there is 
least resistance — the inferior segment ; for it is a well known 
fact, that the muscular tissue diminishes in quantity, and there- 
fore, in power, from the fundus towards the orifice. Whilst the 



40 Artificial Rupture of the Amniotic Sac. [January, 

inferior segment is undergoing distension by the downward pro- 
jection of the liquor amnii, the superior portion of the cavity is 
lessened, and the walls of the body and fundus permitted there- 
by to apply themselves more closely upon the child. Then, 
as the cervix continues to dilate, and the os begins to open, 
further descent of the liquor amnii is allowed; so that the pro- 
portion of the uterine force transmitted to the pelvic brim, 
through the body and head of the child, increases step by step: 
As the os continues to open, and the membranes are more and 
more exposed to rupture from diminishing support inferiorly, 
the increasing contractile power of the uterus would certainly 
rupture them, were it not that, as the labor progresses, the pro- 
portion of force transmitted to, and extended upon the pelvic 
brim, through the child, is gradually increased. This is a wise 
provision of nature, for if the undivided power of the uterus 
should be exerted upon the unsupported membranes at the 
orifice as alleged by Prof. Murphy and others, rupture of them, 
unless preter naturally strong, would be inevitable at an early 
period of dilatation, in a large majority of first labors. As the 
labor progresses, the uterine walls are applying themselves more 
firmly upon the child, during each contraction, and the head is 
being flexed, so as to bring its smallest circumference in relation 
to the superior strait. Now suppose that at an early period of 
dilatation, and before flexion of the head has proceeded to any 
considerable extent, the amniotic sac is ruptured, either from fra- 
gility of the membranes, or interference on the part of the medi- 
cal attendant; what results? Usually, abnormal protraction of 
delivery, and injury to the child and mother proportionate to its 
duration. The cervical segment being relieved from distension, 
by the evacuation of the liquor amnii, retracts by its elasticity, 
and applies itself closely upon the presenting part, and does not 
come to be pressed upon until the head is completely flexed, and 
its sub-occipito-pregmatic circumference is passing through the 
superior strait. When the head is of due relative size, this step 
in the mechanism is never attained in the early period of dilata- 
tion, unless the cervical tissue is preternaturaily unyielding. I 
therefore venture to assert that the statement of obstetrical wri- 
ters, — Prof. Murphy included— that the ruptured amniotic sac 
is replaced by the vertex, which, by pressing upon the os uteri, 
irritates and renders it unyielding, thereby causing the tedious- 
ness which usually results where the liquor amnii is early evacu- 
ated ; is entirely and radically erroneous. Further, it is a mere 
assumption to assert, that when the vertex, (covered by the soft, 
well lubricated scalp,) does come to press upon the os, it will 
irritate, inflame, and render it unyielding ; for when in the pro- 
gress of labor, the occiput descends, it will dilate the orifice as 
favorably and as rapidly as the other unfavorable conditions 



1858.] Artificial Rupture of the Amniotic Sac. 41 

will admit. Again, the theory implies that the delay will termi- 
nate with the full dilatation of the os, whereas it is a fact, that 
the delivery is delayed at evey step throughout, by the two early 
evacuation of the liquor amnii. We have heretofore stated, that 
at an early period of dilatation, the head is but imperfectly 
flexed, and is not yet so adapted to the pelvic orifice as to pre- 
vent the outflow of liquor amnii, produced by the recurring 
"uterine contractions. Complete flexion, and adaption of the 
sub-occipito-pregmatic circumference of the head to the pelvic 
brim, is by far the most tedious step in the mechanism of a 
primiperae labor ; usually requiring many hours for its accom- 
plishment. The liquor amnii being thus gradually and com- 
pletely expelled, the uterine parietes are permitted to close upon 
the unequal surface of the child. The circular fibres of the body, 
meeting with the least resistance, contract upon and constrict 
the abdominal region of the foetus. Each succeeding contrac 
tion increases the constriction, until the compressed part be- 
comes as resisting as the other portions. The child can only 
be expelled from the uterus by being made to glide upon its inner 
surface, and anything that militates against this process, will 
retard delivery proportionately. Now, as the resistance of the 
presenting part, conjoined with the resistance of this constriction, 
must be overcome by the contraction of the cervico-fundal fibres ; 
the true cause of tediousness is at once made manifest ; for the 
amount of power absolutely lost, is exactly equal to that which this 
constricted portion of Hie uterus is capable of exerting. And this 
relation of the uterine parietes will, at least, be partially main- 
tained at every subsequent step of the labor, until the head is 
delivered ; thereby causing abnormal delay throughout. 

Through the foregoing explanations, it will be perceived,- that 
protraction and injury are liable to result, whenever the liquor 
amnii is evacuated before the head is properly adapted to the pelvic 
orifice, no matter what degree of dilatation may have taken place. 

We have thus undertaken to show, " that one of its most 
important uses (the amniotic sac) remains unfulfilled until the 
presenting part has passed through the superior strait ; and that 
in all nutural, uncomplicated labors, especially primiperae, the 
membranes should not be ruptured at any time." 

In case of actual inertia, the practitioner must exercise his 
judgment, in view of the conditions present; but rigidity of the 
membranes can in no way impede the descent of the presenting 
part through the pelvic brim. Therefore it is my deliberate 
opinion, derived from careful and extended observation, that 
rupture of the amniotic sac, especially in primiperae cases, before 
the head is properly adapted to the pelvic orifice; is injudicious, 
and generally injurious, and sometimes fatal, — especially to the 
child, in its results. For, the altered condition of the uterine 



42 Cathartics in Dysentery. [January, 

sinuses and the placenta, consequent upon prolonged and undue 
retraction of the uterine parietes, in conjunction with the violent 
pressure to which the infant is subjected; are well calculated 
seriously to impair the child's viability, even though it may be 
born alive. 

There are other and important objections to rupturing the 
membranes, even when the os uteri is well dilated. Who knows 
at what period of a labor eclampsia may occur? Version may 
be desirable, but difficult and dangerous if the waters have been 
long evacuated. The same may be said in regard to rupture of 
the uterus. So also, of haemorrhage ; the first expedient being 
rupture of the membranes, the next, version. 

In conclusion : as it is difficult to estimate in a given case of 
labor, to what extent its bad results may be fairly attributable 
to improper management, we may feel disposed to rest satisfied 
with our preconceived ideas and modes of practice. Let us, 
however, be reminded of the statistical fact, — established by the 
observations of Burns, Collins, JNTagaele, Simpson and others ; 
that the liability to injury and death, upon the part of the mother 
and child, increases proportionately with the duration of labor. 



Cathartics in Dysentery. By 0. C. Gibes, M. D., Frewsbury, 
New York. 

At the meeting of the Buffalo Medical Association, Sept. 2d, 
1856, as per report of proceedings in the October number of 
the Buffalo Medical Journal, a discussion took place in regard 
to the propriety of using cathartics in dysentery ; also the kind 
of cathartics best calculated to fulfill the indications in that dis- 
ease. As this question is fairly before the readers of the Jour- 
nal above mentioned, we suppose it is open for the expression 
of opinion or experience, by any of its many readers. Hence 
we give expression to a few thoughts, based partially upon our 
individual experience, and partially upon the generally received 
opinions in regard to the nature of the affection under consider- 
ation. A knowledge of the nature or pathology of any disease, 
is, perhaps, the surest guide to the appropriate indications of 
treatment. The public generally, are apt to look upon all 
diseases accompanied with frequent evacuations from the bow- 
els, as similar at least, if not identical in character. Physicians 
themselves are not always free from this vagueness of nomen- 
clature. In muco- enteritis, as well as milder forms of mucou9 
irritation, each case is accompanied with a diarrhoea or frequent 
alvine evacuations, and the public generally do not discriminate 
between such cases and dysentery, and we have seen physicians 
not unfrequently, if not guilty of the same error in diagnosis, 



1858.] Cathartics in Dysentery. 43 

at least of the same vagueness of nomenclature. Dysentery con- 
sists in an inflammation of the mucous membrane of the colon 
and rectum, and, though the evacuations may be over in ten 
minutes, yet, except it may be in the incipiency of the disease, 
they are not fcecal, but consist almost wholly of mucous and 
blood. Hence, though the griping pains in the abdomen and 
the tenesmus may be never so great, though the characteristic 
muco-sanguineous evacuations may be never so frequent, or the 
straining at stool never so persistent, the case may be accompa- 
nied with obstinate constipation. The public generally look 
upon the frequent bloody evacuations as constituting the whole 
of the disease, and, consequently, urge the importance of power- 
ful astringents, which, if unadvised by the attending physician, 
they sometimes clandestinly and injuriously bring to bear upon 
the disease. But the physician who resorts to them, to the ex- 
clusion of evacuants, will certainly have no reason to boast of 
his success. 

Permit us to say, that we do not propose to discuss the nature, 
cause, or symptoms of dysentery, nor to enter into full details 
of treatment. We propose only to make a brief expression of 
our opinion, upon the question under discussion, viz : the pro- 
priety of cathartics in dysentery. 

Some authorities have condemned the use of evacuants in 
dysentery, on the ground of their supposed irritating influence 
upon the inflamed mucous membrane. But we feel confident 
that, when the evacuant is judiciously selected, and repeated 
with due discrimination, and with proper adjuncts, its irritating 
influence is more fancied than real. The object of the cathartic 
seems, at first, to be to free the bowels from irritating secretions, 
and the object of their repetition is, conjoined with the above, 
to prevent constipation, which is the inevitable sequence of the 
inflammation and consequent fever. A second, and not less 
important object to be secured by the evacuant, is to unload the 
portal veins, thus diminishing congestion in that important 
circulatory system, and to stimulate the capillary circulation in 
the liver, which is often sluggish, resulting in a deficient biliary 
secretion. 

In regard to the choice of a cathartic there has been and is a 
great discrepancy of opinion. Some have advised calomel at 
first, to be succeeded by castor oil ; others have advised castor 
oil from the first. Ehubarb, compound powder of jalap, cream 
tartar, epsom salts, rochelle salts, &c., have all had their advo- 
cates. 

We were formerly in the habit of giving, at first calomel in- 
timately commingled with rhubarb and a little pulverized opium, 
and afterwards, whenever an evacuant seemed demanded, 
gave castor oil with a few drops of laudanum. But recently 
2* 



44 Cathartics in Dysentery. [January, 

we have made choice of a different evacuant, and, so far, have 
been much pleased with the change. In the June number of 
the Western Lancet, for 1855, Dr. D. B. Dorsey communicated 
the result of twenty years' experience with a cathartic mixture, 
first proposed to him by Dr. Lemoyne, of Washington, Pa. 
Summing up his result he said " in a practice, not very limited, 
in the cities of Wheeling, Ya., and Steubenville, 0., in the lat- 
ter of which dysentery prevailed as an epidemic twice or thrice 
during my residence there, I had the high gratification of seeing 
all recover who were treated with this remedy from the com- 
mencement of the attack." With this high encomium before us, 
we made trial of the combination in the next case that came 
under our observation, and with such happy results that, except 
in young children, we have used it in all dysenteric cases since, 
with success in all cases. 

We quote Dr. Dorsey's formula and directions from the paper 
above referred to. " Take of saturated solution sulph. magnesia, 
seven fluid ounces ; aromatic sulphuric acid, one fluid ounce — mix. 

" The saturated solution is prepared by dissolving epsom salts 
in an equal quantity of water, by weight, at 60 deg. Fahrenheit. 
It will be ready for use in eight or ten hours. During that 
time it should be shaken occasionally. 

''The medium dose of this medicine for an adult, is one table- 
spoonful, delivered with two or three ounces of water, every 
four to six hours, until it gently moves the bowels. It should 
be given regularly, and perseveringly, until the bowels are man- 
ifestly under its influence, which will be evinced by feculant 
discharges, abatement of tenesmus, and general feeling of relief. 
The size of the dose and time of repeating it, must be varied by 
the practitioner's judgment, according to many circumstances 
of age, violence and stage of disease, &o. Sometimes it will re- 
quire two tablespoonfuls of the medicine, every three or four 
hours ; at others a teaspoonful every six or eight hours will be 
sufficient. 

" Accompanying each dose, when the pain and tenesmus are 
great, one sixth of a grain of sulph. morph. may be given. But 
this remedy, also must be varied, both in quantity and frequen- 
cy of repetition, according to circumstances." 

We have seldom or never exceeded tablespoonful doses, and' 
oftener fallen below that. But instead of giving once in four 
or six hours throughout the twenty-four, we have usually com- 
menced with it in the morning, to be repeated every three hours 
until it operates, always combined with a small quantity of 
morphine. This course we repeat every day so long as the in- 
dications demand. During the remainder of the twenty-four 
hours, we give ipecacuanha with morphine, or such other rem- 
edies as the circumstances of the case seem to require. It may 



1858.] Puerperal Vomiting. 45 

not be amiss to say here that mercurials are incompatible with 
the mixture. 

The acid doubtless stimulates the capilliary circulation in the 
liver, promoting bilious secretion, while the sulphate of magne- 
sia relieves the portal congestion and frees the bowels from ir- 
ritating secretions. From the relief which speedily follows its 
action, to the tormina and tenesmus, greater than that following 
any other evacuant, we cannot help thinking the acid has a 
direct sanitary influence upon the inflamed mucous membrane. 

With young children, where smallness of dose and pleasant- 
ness of taste are always considerations of much importance, the 
above mixture is decidedly objectionable. The taste is rather 
disagreeable, and the necessity for diluting the mixture, renders 
the bulk such as no child will readily take. In such cases we 
have been in the habit of scorching rhubarb, adding boiling 
water and extract of hyosciamus, the dose of such proportion to 
the age and condition of the patient, sweetening the mixture 
and flavoring with nitre. 

This is to be given in repeated doses in the morning, sufficient 
to produce a laxative effect, and during the balance of the day 
we give hydrargyrum cum creta, in small doses, with Dover's 
powders, or such other medicines as the circumstances of the 
case may indicate. — [Buffalo Med. Journal. 



Puerperal Vomiting cured by the Induction of Labor. By Fran- 
cis W. Sheriff, M. D., L.K.C.S.E. 

Having recently read your article on Professor Cazeau's late 
work on the Diseases of Pregnancy, &c, I thought it might be 
interesting to some of your readers to relate a case of severe 
Puerperal Yomiting which lately came under my care. My 
patient, Mrs. Moore, first consulted me four years ago, being in 
the eighth month of her fifth pregnancy. She complained of 
almost constant vomiting, and had been reduced to great debil- 
ity by absolute inanition. A few doses of hydrarg. cum creta 
and opium checked the vomiting, and she was delivered of a 
healthy child at the proper time. The placenta was retained, 
and she had considerable hemorrhage before I reached her resi- 
dence, which was about nine miles distant. She became anae- 
mic and was confined to bed for nearly three months. She 
eventually was quite restored to health, and has not been preg- 
nant since until this time. On the 26th of July last I was 
requested to visit her. I found her aparently healthy, and robust 
looking, pulse natural. She stated that she was in her seventh 
month of pregnancy and that since its commencement she had 
vomited a great deal, but that lately it had become much more 



46 Puerperal Vomiting. [January, 

troublesome, and that she was afraid of relapsing into her for- 
mer condition, as her bowels were rather costive. I prescribed 
the pills and a mixture of chloroform and tinct. lavand. comp. 
and at the same time paid great attention to the state of her 
bowels. On the 10th of August I was again called to visit her. 
She stated that since the 7th, the vomiting had been almost con- 
stant, that she retained nothing on her stomach and that she 
vomited a great deal more than she swallowed. She complain- 
ed of great thirst, pain in the epigrastrium, great anxiety and 
restlessness, and was urgently calling for relief. Pulse 120 of 
good strength, breath foetid, having the odour of chloroform. I 
bled her to the amount of ! viii. without causing fainting, and 
prescribed at different times calomel and opium, senna, enemas, 
warm applications to the epigrastrium, creosote mixture, &c, but 
all of no avail, the vomiting continued as bad as ever. The 
swallowing of a little fluid of any kind was almost immediately 
followed by great retching and vomiting. The fluids vomited 
were colourless and inodorous, and largely exceeded what had 
been swallowed. In addition to the medicines prescribed, I 
ordered nourishing enemas to be frequently administered. 

11th. Symptoms rather more favorable, vomiting not so severe, 
and has slept a little, complains more of debility, >skin rather 
cool. Has retained a little opium, which she thinks has relieved 
her. 

12th, 8 a. m. — Is much worse, vomiting as bad as ever, ex- 
tremities cold, skin wrinkled and withered like a person in col- 
lapse of cholera. Has very great anxiety, and calling urgently 
for fresh air. Had to get her bed elevated to the height of the 
window so that she might have her head in the open air. Pulse 
130, weak and variable. As it was evident that death must soon 
ensue if relief was not obtained, I determined to bring on labor; 
but before doing so, I requested that Dr. Anderson, a neighbor- 
ing practitioner, might be sent for. He arrived at 3 p. m., and 
agreed with me on the propriety of immediately inducing labor. 
I introduced a flexible catheter into the uterus, ruptured the 
membranes, and drew off about 8 oz. of liquor amnii. My pa- 
tient was relieved almost immediately, and the vomiting ceased. 
I prescribed 1 drachm of tincture of Ergot every two or three 
hours, supporting her strength at the same time with stimulants 
and nourishing enemas. She remained easy and comfortable 
all night, and next morning, about twelve hours after the rup- 
ture of the membranes, labour pains came on, and continued 
regarly all day, but at long intervals. About 8 p. m., I admin- 
istered an enema of infusion of ergot, which soon had a most 
powerful effect, and within an hour afterwards she was safely 
delivered of a living child which cried lustily. It, however, 
lived only about eight hours. My patient rapidly recovered, 



1858.] Physiology of the Ear. 47 

and in two or three weeks was entirely restored to her usual 
health. In this case so urgent were the symptoms and so rapid 
had been the approach of sinking and colapse, that I had no 
doubt that the delay of the operation for a few hours more would 
have proved fatal. From the immediate relief experienced after 
drawing off the liquor amnii, it would appear as if the cause of 
the vomiting had been the pressure of the gravid uterus. 

[Medical Chronicler 



On the Physiology of the Human Ear. By "W. Kramer of Berlin. 

Our knowledge of the physiology of the auditory apparatus 
is still very incomplete, partly on account of the difficulty of 
experimenting on the organs of hearing, and partly on account 
of the imperfection of the science of acoustics. We are happy, 
therefore, to record the results of the investigations of Dr. Kra- 
mer, (Deutsche Klinik, 1855.) whose vast experience in the 
treatment of aural affections is universally known. In review- 
ing the researches of his predecessors, this author points out the 
impossibility of determining what takes place in the living ear 
from experiments on inert matter. His own experiments have 
been made upon the ear itself, in the healthy and diseased states. 
It would be out of the question for us to reproduce the details 
of these experiments ; we must be satisfied with the author's 
conclusions : — 

1. The cartilage of the ear conducts more than a third of the 
sonorous waves which reach the membrana tympani. 

2. The concha is the most important part of the auricula 
cartilage. 

3. The cartilage of the ear, in its natural position, simply re- 
ceives and conducts the sonorous vibrations to the auditory pas- 
sage. 

4. The cavity of the auditory passage transmits about 500 
times as many undulations as the solid parts enclosing it. 

5. The curvatures of the meatus and the cerumen have no 
influence on the sonorous vibrations. 

6. These arrangements serve to protect the canal and the 
membrana tympani from external agents. 

7. The membrana tympani transmits the sonorous undula- 
tions in due quantity and quality, only while its structure is 
normal. 

8. The membrana tympani also serves as a protection to the 
drum. 

9. The ossicula have but little agency in transmitting the 
vibrations of members of the membrana tympani to the laby- 



48 On Rheumatism, &c. [January, 

rinth. Their office is rather to support the membrane between 
two strata of air. 

10. The membrane of the fenestra rotunda is designed espe- 
cially to transmit to the labyrinth the vibrations of the tympa- 
nal cavity. 

11. The mastoid cells are of trifling acoustic importance. 

12. The Eustachian canal is an open tube. (Dr. Toynbee 
had announced a contrary opinion.) 

13. Through this tube the air of the tympanum is renewed, 
and the sero-mucous secretion of that cavity eliminated. 

14. Hearing is not entirely destroyed by the absence of the 
fenestra rotunda and the loss of the liquor cotunnii. — [lb. 



On Rheumatism oftlie Epithelial and ISl on- Epithelial Fibrous Tis- 
sues : Its Sequence to Scarlatina and other Exanthemata. On 
Rheumatic Grout, Chorea, &c. &c* By H. P. DeWees, M. D. 
New York. 

The term "Kheumatism" is derived from a Greek word sig- 
nifying " a fluxion, or catarrh." It is divided into acute and 
chronic, although a third form may be correctly added, viz : the 
flying, or fugitive." The tissues affected are chiefly of the fibrous 
or sero-fibrous class. But muscular structure itself may become 
the seat of the affection, from its component elementary fibrous 
structure. 

The true disorder consists in a certain more or less altered 
condition of the blood, from its normal composition. This con- 
dition may arise from causes apparently most opposite, but which 
resolve themselves into one and the same action, namely : their 
power to change the constitution of the blood from its healthful 
state. 

The bedside statements confirm this view. By some, the ex- 
citing cause of the attack is attributed to cold, or to "check of 
perspiration." By others, to waste of nervous force by long- 
continued watching, to strains, or over-exertion, to being "out 
of order" for a long time, though not conscious of having been 
exposed to damp or cold, to the sudden suppression of a skin 
eruption, to indigestion after a debauch, and so on, till one would 
be led to believe that any imprudence might be followed by an 
attack of rheumatism. 

In some families it is, apparently, as hereditary as the gout ; 
whilst in the gouty it is not unfrequently a conjoined affection. 

_ * Some of the views announced in this paper are so like those given in the ar- 
ticle on Scarlatina, published in our pages, that our readers may suppose they 
were suggested by it. It is due to the author to state, that the present paper 
has been ready for publication three years. — [Eds. Monthly. 



1858.] On Rheumatism, &c. 4& 

But the gouty, from their mode of life, are more apt to superin- 
duce rheumatism, than are the rheumatic to earn gout. Where 
the parents of the patient have been subject, one to gout and 
the other to rheumatism, a sort of hybrid attack may sometimes 
result, rendering diagnosis difficult, whilst relief can only be 
obtained by conjoining the remedial measures of each. This 
coalescence, however, is not always the case, as I have seen 
gout and rheumatism run their distinct course in separate attacks 
in the same person. Eheumatism may safely be termed a blood 
disease. This blood condition may arise from causes apparent- 
ly very different, but which resolve themselves, in their final 
result, by producing alike morbid changes not only in the cir- 
culating fluids, but in the nutritive action of the tissues them- 
selves. Xor does time, or any specific interval, form a necessa- 
ry element in the anormal production. It may result suddenly, 
or may be the sequence of the gradual want of integrity in the 
healthful assimilative functions. The sudden cutaneous sup- 
pression (so prolific a cause generally,) by which certain excre- 
tory elements are forced to remain in the blood, loading it with 
a specific poison, and resulting in the phenomena of rheumatism, 
may be represented in a like manner by the errors of an organ 
or organs, by which a similar toxic condition of tlte blood may be 
induced. Kor is it necessary, that the superficial excretory 
actions, or the internal assimilative organs themselves be impair- 
ed — both may work in their perfect normal role, yet from the 
supply, by diet, being improper or in excess, a state of blood 
similar in its impurities may be produced, with the exhibition of 
rheumatism or gout as its index. It is only thus that the various 
accounts as to the origin of the attack can be reconciled. 

The acute rheumatism of children, in almost all cases, can be 
readily traced to improper exposure or to damp. The recession 
of so much highly animalized excretion as is constantly being 
thrown from their surfaces, loads the blood with excrementitious 
products, whilst the proper actions of the kidney, liver, &c, are 
interfered with ; or congestions may be superinduced, which 
cannot but serve to usher in the disorder. The young are more 
liable to general rheumatism than are the more advanced ; and 
heart disorder is more prone to ensue in them than in the latter. 
This, most probably, is owing to the higher condition of irrita- 
bility of the cardiac tissues from the altered blood, and from the 
fact of the exanthematous diseases, as scarlet fever, measles, &c, being 
of later occurrence ; leaving the great excretory organs in a more 
or less damaged state. The determination of the disease, both 
in the young and the more advanced, to become local or general, 
apart from the considerations just mentioned, is in strict accor- 
dance to the blood condition, and the resisting power of the part 
exposed. For example: two individuals of the same age may 



50 On Rheumatism^ &c. [January, 

be subjected to similar atmospheric causes, yet the result may be, 
and generally is, different : one being attacked with rheumatism 
of a single part, whilst the other may be taken down not only 
with the local selection, as in the first, but with every joint in 
the body affected. Or he may escape the like local manifesta- 
tion, and be attacked in the knee or feet, although these parts 
were not only well protected, but not exposed at the time to the 
impinging draught ; thereby clearly showing the relation of the 
blood condition to the disorder. In many cases, the selection 
for the rheumatic outbreak is in some part previously weakened, 
as by strain or fracture, or by local nervous loss. These cases, 
however, require great discernment, as local phlebitis or puru- 
lent deposit in or near a joint may, and has been frequently mis- 
taken for true articular rheumatism, giving rise to the opinion of 
its terminating in suppuration, more often than it does. To 
these and other points I shall again refer in their proper order. 

Although for the most part the attack of the acute rheumatism 
is sudden, yet in some, distinct warnings occasionally take 
place before a " first instalment" is paid in. These premonitions 
vary in different persons according to the attack dating from 
exposure, or from its being kindled spontaneously by previous 
disorder of the blood, without any outward exciting cause of a 
recognizable kind. Disturbance of the digestive organs, attended 
by flitting pains through the joints or in the muscles — the sud- 
den eruption on the skin of some herpetic or other disorder, 
attended with burning, itching, or aching, and its rapid evanes- 
cence — or, the drying up of any chronic discharge, the appear- 
ance of a singular sour-smelling perspiration whilst in bed during 
sleep — these, with other premonitions, serve as sufficient data of 
the impending evil, to those who have already suffered, or are 
remembered with dread at their subsequent appearance, by those 
who did not translate their bearing correctly. In others, no 
such unpleasant " avant-couriers" announce the attack; but a 
peculiar nervous excitability, attended with moist skin, and a 
sensation of feeling better than usual, is recorded by the patient 
— the attack being generally attributed to check of perspiration 
on going into cold air from a warm room, although others who 
were in the same atmosphere did not feel over-heated. 

Here the disease early manifests itself by the usual sweating, 
but in advance of the pain. This, however, soon invades the 
insteps, ankles, knees, or wrists, attended with more or less 
chilliness, hot flashes, and increased perspiration. The arteries 
throb quickly through the now swollen, mottled, hot, and shin- 
ing parts, whilst the superficial veins leave their dark-blue 
traces through the sensitive skin. As the location is variable, 
so is the duration of the intolerable agony uncertain. One or 
both corresponding articulations may be attacked, alternately or 



1858.] On Rheumatism, &o 61 

simultaneously ; or, shifting from ankle to knee, a running fire 
from joint to joint may be kept up, till apparently reinforce- 
ments of the disease arrive, and every joint be tensely invested 
by the relentless enemy. Voluntary motion now becomes im- 
possible, or is effected under the greatest torture. Change of 
position by any aid is rendered agonizing, whilst the desire to 
move increases hourly ; and the patient is worn out between the 
increasing sweats, which bring no relief to the severity of the 
pains, and the sleepless restlessness for change of posture, which 
adds no comfort. The pulse hammers on, increasing in rapidity 
and pain-bearing force through the disabled parts. Fever seems 
firmly established in every essential form, save the dripping 
skin, whose sour sweatings fail to moderate the heart's over- 
action ; and that the after effects are unlike those which would 
be dreaded in other fevers, attended by so much apparent in- 
flammation, and with local disorder of nutrition of such threat- 
ening aspect. 

A respite is generally gained during the sun hours, but the 
night comes loaded with terror. Sleep is now broken from the 
startled slumberer, by spasmodic jerkings of the limbs; and the 
dread of their re-occurrence, robs the pain-snatched hours of 
their balmy gift. And thus passes night into day, pain into ex- 
haustion, and labored conversation into incoherent wanderings, 
or delirium, more or less persistent during the weary night 
hours. The appetite is gone, whilst the thirst is unquenchable. 
The countenance, for a time flushed with dark purple blood, 
bearing evidence of the riot of the heart, and its over-loaded 
condition from the wasting tissues, becomes at length heavy and 
pale-sodden, whilst the forehead drips with outstanding perspi- 
ration, and the sclerotic tissues of the eyes become finely pen- 
cilled, and the mucous tears drain from the sticky and often shut 
lids. ' 

From the seventh to the ninth day such is the course of acute 
rheumatism, when relief may come permanently, or by shifting 
the scene of action to other parts, with moderation in degree and 
duration of the pain ; whilst the limb previously affected be- 
comes less unpliant,- although aching with an almost paralytic 
stiffness, as regards progression or action. The patient is a child 
once more, every motion is uncertain ; he totters with his weight,- 
and has, as it were, to learn to grasp again. In some, at this 
period, gloomy inaction, or heart-desponding forebodings har- 
ass the tedious convalescence. In others, although the recovery 
seems certain, the hopes are found delusive, and they again be-- 
come victims to a re-attack. Pain renews its seat, the clothes 
become drenched in the sour sweats, and the morrows are mort- 
gaged in nights of agony. Nor is this relapse always to be' 
dated from imprudence of motion, or of exposure, or of diet, 

N.S. VOL. XIV. NO. I. 3 



On Rheumatism, &c. [January 

which, from the improving appetite, or greater constitutional 
demand of the patient, had been more generous. It may and 
frequently does result from many causes unconnected with mo- 
tion, atmospheric change, or regimen. Amongst these may be 
mentioned in this place, renewed blood disorder, encroaching 
purulent disturbance, the impairment of an organ by a more or 
less rapid hindrance of action from effusion, or by partial degen- 
eracy of normal structure, etc., etc. It is here that the skilful 
physician is required ; not only to guard against present impend- 
ing difficulties, but to restrain, if possible, the disposition to 
organic damage in the various organs; which, if allowed to 
proceed in their stealthy progress, may suddenly shorten life 
before its prime, or leave it as a dreary tenure to the joyless 
sufferer. 

The prognosis, in many cases of rheumatism, depends upon 
the previous condition of the patient. Whether he has*been 
more given to vegetable or animal diet, or to alcoholic drinks; 
also, as regards the state of the primary and secondary diges- 
tion, — if he has had syphilis, or been lately subjected to gonor- 
rhoea, — whether the kidneys have been for a long time diseased 
or disordered, the origin dating from the exanthemata or not, — 
or if the heart has been affected. In females especially it is im- 
portant to know whether they have been subject to hysteria, 
with or without convulsion, or if chorea has at any period of 
life been present, or if the patient has at any time been affected 
by Marsh malaria or intermittent, — whether extensive suppura- 
tion had been present, or chronic eruptions been repelled. These, 
and many other conditions, in connection with the habits, occu- 
pation, and the history of the parents, have to be fully entered 
into, before a just opinion can be formed as regards the progno- 
sis and rational treatment. 

For no disease does there exist in general a more unsatisfact- 
ory selection, or a more discrepant account, as regards effective 
remedial measures, and this amongst medical as well as non- 
medical observers. The indisposition amongst many to regard 
rheumatism as a blood disorder, the real difficulty at times in 
making a satisfactory determination as regards the tissues affect- 
ed, and the, lithic or lactic acid excesses in the circulation, with 
an apparent natural skin excretion, or their non -elimination from 
the blood, with deficient cutaneous action, — these, and many 
other causes, together with the inaccuracy that will attend the 
diagnosis of even the most skilful, render at times, the treatment 
vague, unsteady, and in most cases purely empirical. For every 
one you meet has a remedy with a list of cures. 

The remedial selection, therefore, often requires much acumen 
in distinguishing simple acute or true fibrous inflammatory 
rheumatism, from the affection upon which the various organs 



1858.] On Rheumatism, &c. 53 

have engrafted their assisting vices ; as witnessed in some dis- 
guised states of Bright's disease, or after scarlet fever, or spinal 
derangement, local phlebitis, insidious tumor, long continued 
and unrecognized constipation, etc., etc. 

As acute rheumatism does not necessarily resolve itself into 
chronic, so may it be said that the latter, as a general thing, 
starts its onward course of injury and disfigurement in a stealthy 
and insidious manner, without much painful inconvenience in 
the early steps. There is, as is well known, what may be 
termed chronic acute rheumatism ; that is, where the patient, 
after an acute attack, is never entirely free from aching pain or 
slowly-increasing disablement of the joints, till seized with an- 
other attack, But, as above remarked, chronic rheumatism, in 
most cases, begins stealthily. Antecedent impairment of health, 
at first scarcely noticeable ; fitful pains shooting here and there, 
stiffness of the back or in the joints, on rising suddenly from 
the sitting or lying posture ; skin-aching more intolerable whilst 
warm in bed ; deep, heavy, and weakening pains in the larger' 
muscles, rendering sleep uncertain and uncomfortable ;• frequent 
desire to urinate, sometimes attended with more or less scalding, 
and even with muco-purulent urethral or vaginal discharge^ ren- 
dering a suspicion of, and at times mistaken for, gonorrhoea! 
disorder, — the slow but increasing enlargements of the joints, 
unaccompanied with desquamation or irregular disfigurement, as 
in gout ; the general stiff-hinge movements, — these, and many 
others, being the intelligence to the afflicted that the record of 
their assimilative imperfections, or their imprudence of all hygi- 
enic rules, is most ineffaceably written in their persons. The 
symmetrical disposition to disfigurement is peculiarly noticeable 
in chronic rheumatism, the distortion of one joint, or of its 
burse, being apt to be daguerreotyped in the corresponding part 
of the other side, 

But chronic rheumatism may exist unwritten in joint or mus- 
cle, and even unsuspected by the practitioner and patient, the 
brunt of the disorder falling upon organs hidden to view during" 
life, and whose altered organic condition, with the cause, is only 
revealed by the knife. For what is true in the diffused form of 
gout, is also true in chronic rheumatism. The patient may be 
tortured under the belief of an existing and incurable organic 
disease of an organ important to life ; whilst, in reality, it is only 
laboring under the insidious functional poisoning of unrecog- 
nized rheumatic infection. It has been my frequent opportunity 
to see both the young and the old treated for organic cardiac 
disease, attended with disturbance of action, and all the bruits 
that play their JEolian strains over the strings of the heart, 
when, by addressing the treatment to the rheumatic condition 
of the blood, relief has been gained in a satisfactory, and i» 



54 On Rheumatism, &c. [January, 

many instances, in an almost magical manner. And the same 
may be said of the apparent heart-disease in the gouty, — colchi- 
cum and hydriodate of potash being their best friends. 

In what may be properly termed chronic acute rheumatism — 
that is, in persons subject to frequent attacks of the acute form 
with slow recuperation — the heart is liable to become affected in 
about thirty in one hundred cases, and this, especially in chil- 
dren, from seven to fifteen years of age. In the plurality of 
these cases, the previous exanthemata, as scarlatina or measles, 
"most likely laid the foundation, or were associated in the rheuma- 
tic attack. For the valvular lesions so frequently attending 
rheumatism, are not uncommonly preceded by kidney derange- 
ments, which date their origin from causes as above mentioned. 
It therefore becomes needful, whilst seeking into the existence 
and date of an hypertrophied ventricle, (which, of itself, is so 
frequently conjoined with disease of the aortic valves, or if di- 
latation exist, with adhesion to the pericardium,) to enquire if 
the exanthemata had at any time been suffered from. For it is 
undeniable that kidney disease, from whatever cause, frequently 
exists with altered muscular structure of the heart and a high 
irritability in its serous lining membrane. This state is more 
frequently found in females than in males, and thus in part, 
may account for the greater prevalence of choreic disease in 
them. 

As regards selection, the left side of the heart, from its greater 
tendinous structure, is more subject to rheumatic inflammation 
than the right. From the considerations above-mentioned of the 
liability of the heart to previous damage from kidney derange- 
ment, the fact of rheumatic pericarditis being less frequent than 
valvular inflammation, may be accounted for. In many cases 
of rheumatic pericarditis, the lining membrane of the heart is 
found more or less involved, and pleurisy by extension may 
result. Where extensive kidney disorder has existed previous- 
ly, suppurative or purulent inflammation may, and frequently 
does ensue, whilst the ursemic symptoms are prominent ; and 
this, especially, if the patient has been lately subjected to the scarlati- 
nal poison. 

Indeed, pleurisy unconnected with pericarditis, is rare in 
rheumatism, and in some cases, apparently, will be proportioned 
to the amount of urea, remaining uneliminated from the blood. 
The pleuritic effusions sometimes are so great as to displace the 
lower organs, and especially the liver ; leading, on hasty exam- 
ination of the abdomen, to the belief of enlargement of that 
organ, or of tumor, as has been witnessed by me on post-mortem 
inspection, where the serous or sero-purulent collection in the 
left side was so extensive, as to cause a large bag to descend low 
down towards the crista of the ileum ; rendering, during life, all 



1858.] On Rheumatism, &c. 55 

diagnosis unsatisfactory and obscure. Where the effusion is on 
the right side in excessive quantity, and accompanied with 
ascites, the liver may be floated, as it were, and pushed far over 
into the left side, giving rise, also, to the supposition of a tumor 
existing there. 

Hypertrophy of the left ventricle is a most common sequence 
or associate, of disease of the kidneys; and in these cases is fre- 
quently independent of valvular disorder, whilst apoplexy 
forms one of the modes of death. Where rheumatism attacks 
an individual, who previously may have been laboring under 
hypertrophy of the heart, the prognosis is of course more unfa- 
vorable as regards the ultimate result ; as the vessels of the brain 
are apt to become diseased or degenerated in this condition of 
the heart. If disorganization of the kidney co-exist, the danger 
to the patient is also increased ; as the hypertrophic state of the 
heart has a double association. What exact proportion in these 
cases have been affected by scarlatina, I do not know, but it 
appears to me that the number is in greater ratio. 

The peculiar irritable manner and appearance in the patient 
at first, but changing to a dull yet anxious expression, in rheu- 
matism with previously disorganized or impaired kidney, is to 
be accounted for, by the gradual poisoning of the brain and 
great organic centres, from the retention of urea and other ex- 
crementitious matter in the blood. This condition may be par- 
tially relieved by the occurrence of effusions ; but only for a 
time, as resorption, fresh accumulation, and functional impedi- 
ment by dropsical extent, ensue, whilst convulsion, or coma, 
ends the scene. 

The absorption of urea is by no means to be measured by the 
drowsiness of the patient ; in some it acts as an excitant, produc- 
ing sleeplessness or vivid fancies, as is not unfrequently witness- 
ed after opiates. Indeed, I have seen the utmost watchfulness 
persist ; sleep or coma, only ensuing just before death. It is the 
object of this paper to more than call the attention of the pro- 
fession, to the fact of the frequency of rheumatism after scarlati- 
na, or other exanthemata, and to extreme liability of the epithe- 
lial serous linings of the various parts of the body, to become the 
seat of the disorder, after the kidneys have been disturbed, or 
diseased in their epithelial structure. Hence, the frequency of 
sero-fibrous rheumatism after scarlatina ; and where no kidney 
disorder exists, the preference of this rheumatic affection to the pure 
fibrous structures. In the former, purulent effusions are apt to 
take place, whilst in the latter they are very rarely witnessed, 
though the swelling, etc., is greater. 

The student should carefully divest himself of the too preva- 
lent idea of the metastasis in rheumatism, gout, and other dis- 
eases not strictly confined in certain regional bounds. ; The 



56 On Rheumatism, &c. [January, 

endeavor should be to classify anatomically, the tissues endowed 
with the same organic elements, and having alike functions. By 
bo doing, identity of structure with their liability to functional 
error will usurp the vague idea of the so-called metastasis ; and 
the disturbances of other organs, will resolve themselves into 
their own legitimate actions and re-actions. It is also important 
to weigh the mechanical association, or situation of parts involv* 
ed, and their disturbing influences. For instance, pericarditis 
with adhesion, although highly interfering, still will allow the 
function of the heart to be carried on better than in endo-cardi? 
tis with valvular narrowing of the orifices, or where the natural 
elasticity of the inner mechanism is hampered by thickening, or 
by restraining adhesions ; or, by roughening vegetations oppos^ 
jug an obstacle to the uniform current of the blood, etc., etc. 

The various compounds remaining in the blood from deranged 
elective balance, may act as other poisons do when introduced 
from without. These toxical influences may become directly 
injurious, by completely paralysing the functions of an single 
organ, highly essential to life; or they may, by inducing a grad- 
ual degeneracy of all the nutritive centres, so leaven the whole 
circulating mass, as to render every structure more or less attaint- 
ed in their vital uses. Nor are these effects subjected to any 
regularity, as regards their exhibition. In one, paralysis of mo- 
tion may ensue, — whilst in another, disorder of any special sense 
may result; and blindness, deafness, or insanity, be the product, 
leading, too generally, to the belief of structural degeneration, 
rather than of functional derangement. This subject is full of 
the highest importance, and must ultimately form the platform 
of future improvement in the treatment of disease, before medi- 
cine can be safely called a science. 

These blood poisons act by excess or deficiency of the normal 
ingredients — or by new combinations, not existing in the health- 
ful state — or from the introduction of a specific poison, such as 
the syphilitic, cadaveric, etc., which have the power either to 
arrest the natural blood formations, or to impress upon them a 
new formative growth and self-like, not consonant with the 
normal organic constitution. Cancers seem to be an illustration 
of this. Each of these specific entities, or poisons, have a given 
type -life— in some, without the power of reproduction in the 
same individual (as witnessed in small-pox, measles, scarlatina, 
etc.), running through their periods of incubation, growth, and 
decline, in a regular manifestation of events. In other blood 
poisons no such self-limitation of developement, nor after-inocu- 
lative exemption exists. A disposition to increase without limit, 
and to perpetuate their destructive changes in every tissue, forms 
a prominent feature in them ; as seen in syphilis and cancer. 
J3ut these latter kinds are more amenable to early treatment, or 



1858.] On Rheumatism, dx. 57 

to death by remedy ; or, in other words, to cure, than the form- 
er. It is, however, a curious fact, as regards the development 
of syphilis amongst the Northern Esquimaux, that even this 
poison, so frightful in its ravages amongst civilized and warmer- 
climed people, runs in them from the primary stage to complete 
eradication, in six months, without treatment of any hind. For 
this fact I am indebted to my distinguished friend Dr. Kane.* 

A slight outline of some of the disorderly associates of rheu- 
matism, and of those affections attended with pain apparently 
rheumatic, but dating their origin from other morbid conditions, 
may be proper here. Rheumatism is not only frequently con- 
joined with scarlet fever, but is exceedingly prone to afflict 
persons who have been subjected to this disease, or to other of 
the exanthemata. From the views early mentioned, this might 
be suspected, since the kidney is also liable to suffer greatly in 
this fever. "Where the renal derangement is early manifested, 
the pains in the joints is apt to make a corresponding appear- 
ance, and will frequently mask the attending scarlatinal affection, 
or cause it to be entirely overlooked if feebly developed ; the 
delirium, convulsions, or increasing coma that may attend, giv- 
ing rise to the surmise of translation of the rheumatic action to 
the brain, or its coverings. In these cases of apparent rheumatic 
origin, it therefore becomes important to investigate closely into 
the exact condition of the child, as to its exposure to scarlatinal 
infection, or to the epidemic influence at the time prevailing. 

The subsequent difficulty about restoration to general good 
health — the desquamations — the sudden chest difficulties, or 
dropsical effusions, ensuing shortly after, and even without in- 
cautious exposure, on the subsidence of arthritic pains — these 
many times serve to point out what has been overlooked. In 
none of the exanthemata is untimely exposure more severely 
witnessed than after scarlatina. Another fact is well worthy of 
consideration, viz : the albuminal persistence in the urine, to- 
gether with tubular casts, epithelial deposits, etc If this condi- 
tion is found to exist in a case of sudden but ill-defined rheuma- 
tism — and more especially in children who have never been 
known to have had scarlatina, attention should at once be di- 
rected to the probability of the incurrence of this affection, and 
to the fact of the engagement of the kiclnej'S. 

The rheumatic symptoms generally do not exhibit themselves 
in the commencement. The scarlatinal disease may have been 
declared some time, even to the period of desquamation, before 
the joints are complained of. But whenever this may happen, 
and the kidneys are becoming more or less deranged, the danger 

* This paper, it will be remembered, was written before the death of this 
noble man. 



58 On Rheumatism, &c. [January, 

is great, not only for the present but for the future ; since the 
effusions into the joints are at times amongst the lesser evils, the 
heart and brain being the special organs for anxiety. The effu- 
sions within the joint, although they may not be great, may 
eventuate in suppuration (as in purulent synovitis), producing 
more or less permanent alteration of structure and model, from 
mere thickening to articular caries. 

In all cases of diseased joints in children, the strictest inquiry . 
into the preceding disorders, and especially as to scarlatina, then 
becomes of vital importance. As is found in the destruction of 
the aural bony-chain and surfaces, being confined mostly to one 
side, so, in the articular, is one joint, especially the knee, more 
frequently injured. Where the history of the case is imperfect 
or obscure, still, by the careful examination of the urine, even 
at a late date, much information can be gained ; as by it, we 
can often obtain a satisfactory diagnosis between the affection 
being the result of true fibrous rheumatism, to which it may 
have been attributed, or of the involvement of the articular fibro- 
serous membrane, with kidney derangement. This portion of 
the pathology of joint affections is worthy of serious considera- 
tion, and the prognosis must ever be uncertain without it. Most 
medical and surgical men can recall cases where the history of 
the affection, or the successful result of treatment, will prove the 
truth of these views. It is nothing new to attribute the abscess- 
ular conditions of the ear, or the ossicular caries, with sloughing 
of the tympanum, to the after effects of scarlatina. But the in* 
juries to the joints, and other parts, have not met as ready 
observation, owing probably to the descriptive statements given 
of the pain, leading to the idea of simple rhematism of the non- 
epithelial fibrous tissue, 

Both old and young have been, and will be time and again, 
treated for apparent rheumatism, where the affection owed its 
origin to sub-fascial abscess, or impinging deposits of pus, either 
of local origin or from purulent absorptions. Scarlatina, typhus 
fever, local injuries, etc., may all produce this condition, and 
the errors of treatment may at times be pardonable, but in gen- 
eral are dependent upon ignorance or carelessness. In children, 
rheumatism more frequently terminates with suppuration than 
in adults ; and their more recent exposure to scarlatina readily 
accounts for this. But in the older, a diseased condition of the 
kidney, with epithelial-disintegration, frequently takes place. 
In these, rheumatism of the internal sero-flbrous membranes of 
the joints is prone to ensue, and pus may be generated. The 
results, then, are nearly the same, the difference being marked 
chiefly in the higher nutritive changes which take place in the 
young. In scarlatinal-rheumatism, the joints are not the only 
sufferers when the kidney has been damaged. Any parts hav- 



1858.] On Rheumatism, d-c. 

ing the fibro-serous element, may become the seat of derange- 
ment. Hence heart disease, pleurisy, arachnitis, with intra- 
cranial effusions, may result ; and the time of their demonstra- 
tion will be variable. It may be shortly after the attack, or 
proceed so stealthily or slowly, that even adult age may be 
reached. For disease is not a running horse, to be timed exactl}*. 

The modes of death in the child and in the adult are some- 
what different. In the child, the hypertrophic condition of the 
heart is less frequently attended with valvular disorder ; and the 
changes in the vessels of the brain, by which apoplexy, from 
rupture, is so often accomplished in the adult, rarely proceed to 
very great disorganization. But a fatal issue may speedily 
attend with convulsion and coma, from the higher impressibility 
of their nervous system. The arachnitis of the convexity of the 
brain is rapidly ushered in with alarming symptoms. The pain 
is intense, and the sleepless irritability attending from the first, 
alternates with delirium more or less marked, till convulsion or 
coma may close the scene. But the symptoms, when the base 
of the brain is affected, though less prominent, are more on that 
account, to be dreaded, from their insidious character. Pain is 
not much complained of, and the delirium, if any, is less pro- 
found ; but the coma is more sudden and quickly fatal. 

In the adult, the hypertrophy of the left ventricle, (sometimes 
of the heart, independent of any valvular disorder,) accompanied 
by kidney disease, gives rise to, or at least is often associated 
with, alteration of the vessels of the brain, extending to more or 
less profound degeneration of their coats. Hence, apoplexy — 
sometimes sudden and fatal, as from the stroke of a hammer — 
is not an unfrequent consequence ; or softening of the brain 
may come on with rapid strides or stealthy step, rendering life 
uncertain, or held at expense of motion, or intelligence, accord- 
ing to the extent and its seat. 

In the child, the pale, pasty skin, the fretful restlessness, or 
the listless inactivity, varying according to the greater or less 
power in the surface and kidney to depurate the blood — the 
errors of motion, or perception, or of any special sense ; these, 
and many other indications, should always attract to the threat- 
ening condition. That much permanent benefit can be obtained 
by any treatment, where organic changes have proceeded so far, 
is not always to be expected ; but it will be satisfactory to know 
that the state of the patient had been noticed, and that death did 
not claim its victim before any rational measures for the pro- 
mulgation of life, or mitigation of suffering had been entered 
into. 

The choreic disturbances in children (and especially if they 
have been subjected to scarlatinal infection) dating their origin 
more or less closely after an attack of rheumatism, are well wor- 



60 On Rheumatism, Sec. [January, 

thy of notice. In many cases the chorea is the first symptom 
attracting notice to the condition of the heart. When rheumatic 
inflammation has been seated in the lining membrane, St. Vitus's 
dance has been so frequently a sequence, that it is, by many 
viewed in the relation of cause and effect. And this opinion, 
in many cases, seems verified. As above observed, the muscu- 
lar irregularities sometimes cause the detection of the heart's 
injury for the first time. The interval between the occurrence 
of the rheumatic disturbance and the chorea is irregular ; whilst 
the prognosis as to the subsidence of the choreic motions from 
heart complications, depends on the power of arresting the 
damage, and the capability of improving the general nutritive 
system. If the latter can be accomplished, the remodeling as it 
were, of the heart, keeps pace with the progress of growth in 
the patient. At times, however, the heart is so slightly disturb- 
ed as not to indicate any appreciable organic difficulty, although 
sufficient irritability is established to reflect upon the spinal 
nerves the disturbances of relation. It is in these latter cases 
that the metallic tonics, such as arsenic, zinc, oxide of silver, act 
so rapidly in cure. But in the graver cases, where the heart is 
more seriously affected, time forms one of the chief elements, by 
allowing the reproductive changes to ensue with the growth. 
In these cases is witnessed the reason of the insignificance of 
remedies which had proved so beneficial in others. Independ- 
ent of any heart or kidney disease, the errors in the composition 
of the blood after rheumatism, or any other blood disorder, may 
act as frequent causes of disturbances of innervation. Hence, 
stimulant tonic, or sedative treatment, may be called for : in 
one the reproductive actions being below par ; whilst in the 
other, a want of relation between the blood and the assimilative 
power of the tissues themselves may be at fault. A third cause, ap- 
parently, may be independent of any blood relation, and exist 
in the nervous centres, or the nerves themselves. In this way 
the proneness of chorea to be a one-sided disease may be ac- 
counted for. 

The tendency to rheumatic complaints in a family where 
scarlatina has been irregularly developed, sometimes affords a clue 
both as to the nature of the attack and its relief. For it is not 
uncommon to find one child subject to rheumatism, and another 
having chorea without any apparent rheumatic affection. In 
these, fright, which in general is a highly productive agent, acts 
readily and violently. After twelve or fourteen years of age, 
private abuse, through the reflex actions of the spermatic 
branches over the heart and the nervous masses at the. base of 
the brain, may produce alike disturbances. The bellows sound 
of the heart and in the great arteries in tjiese cases resemble, in 
a measure, the bruits from more serious organic difficulty. 



1858.] On Rheumatism, <Cr. 61 

Fright is more commonly an excitor in the rheumatic or debili- 
tated, than in sound and robust children. The development of 
the attack is also more immediate after fright, than after rheu- 
matic disorder. "Where the urine is of high specific gravity, 
depositing lithates or oxalates, and overcharged with urea, and 
the patient does not become correspondingly weak and emaciat- 
ed, the error lies chief!}' in the diet being in excess to the assim- 
ilative powers. The blood here represents the conditions favor- 
able to acute rheumatism ; and if previous kidney derangements 
had been engrafted from exanthematous disease or other cause, 
an attack is apt to follow. But if the individval be free from 
any renal difficulty, the rheumatic attack may not be fully gen- 
erated, but disturbances of nutrition or in the assimilative bal- 
ances may ensue, with chorea as a result. 

Stammering in children, may sometimes be traced to the same 
causes and yield to proper treatment. As in chorea, fright, or 
other emotional excitement, has also been a prolific agent in this 
affection. Indeed, stammering might be called a chorea of the 
tongue^nd larynx. Almost every practioner, and layman, can 
recall cases of early impediment, which subsided gradually with 
the increasing growth and strength of the person. 

Excepting in those cases of sudden and continued violent 
chorea, where the nervous exhaustion is so great as to defy 
timely repair, the prognosis, for the most part, is favorable ; and 
even in choreic paralysis, a happy termination may be safely 
anticipated, if the kidneys regain their normal actions. 

It is not difficult to understand, when the conditions of the 
blood or of the heart and kidneys in rheumatism are known, 
that dropsy may be a sequence — its severity dating from its de- 
gree, time, and place. Nor would it be, as it often is, a matter 
of surprise to the relatives of the patient, who have wondered at 
the apparent over-attention of the skilled practitioner, were his 
anxieties as to the issue of the case known, as long as the purr- 
ing sounds of the heart and the cellular puffiness about the eyes, 
and the epithelial and albuminous deposite continue. 

Diffused gout is sometimes mistaken for rheumatism; the lia- 
bility to cardiac pains, palpitation, etc., adds to the belief. But 
the history of the patient, his mode of living and appearance, 
the family diathesis, and the success that may have attended the 
previous administration of remedies, serves to clear away any 
difficulty in the diagnosis. 

As instances of rheumatic origin may be mentioned, the sud- 
den attack of lumbago, pleurodynia, crick, stitch in the inter- 
costals, the muscular achings whilst at rest or after getting warm 
in bed, or the dull and heavy pains, attended with a sense of 
coldness in the part, etc Yet it may be well to mention that 
all these may be the result of long-continued constipation, and 
will frequently take their flight after a brisk purge, 



62 On Rheumatism, &c. [January, 

There is a painful affection of the skin, termed dermalgia, that 
I will refer to. This affection, so afflicting to the patient at 
times, is by no means unfrequent. It is a somewhat common 
companion of hysteria; and from this fact, I have been led to 
regard some of the forms of this protean malady, as offshoots of 
rheumatism, or at least as indicating a rheumatic tendency in 
the blood. In many cases I have detected epithelial deposits, 
tubular casts, etc. From much opportunity in witnessing ute- 
rine disease, the frequent connection of hysteria with painful 
menstruation, has satisfied me that rheumatism plays an import- 
ant part in it, and it also does in many cases of dysmenorrhcea 
unattended with hysteric phenomena. In apparent spinal dis- 
order, this painful tenderness in the skin is a common attendant, 
and sometimes exists to such an extent over the processes, as to 
lead the unwary examiner into the belief of severe local injury. 
By pinching up the skin, and then making the same amount of 
downward pressure, this suspicion can be frequently dispelled, 
as the pain will be found much lessened, or at least not increas- 
ed. The same condition exists also in certain gouty individuals, 
the increasing tenderness in the skin being many times a fore- 
runner of an acute attack. 

I cannot refrain from attracting attention, in this place, to a 
painful condition of the surface in children, the slightest touch 
being complained of. It is frequently the forerunner of severe, 
if not fatal convulsions, and evidences great functional or organic 
derangement of the nervous centres. When noticed, no time 
should be lost in making such applications to the spine, and 
base of the brain as may be demanded. If fortunate enough to 
be attracted early to this symptom of superficial pain, the con- 
vulsions may be rendered lighter, and of less duration. But 
unfortunately this condition sometimes remains unnoticed, or 
has made such progress when noticed, that the exhaustion from 
the convulsions is so profound, that organic repair and nervous 
recuperation do not ensue ; and the child dies, either after a 
succession of rapid convulsive efforts, or becomes comatose, and 
sinks without a sign into its last sleep. These cases I have seen, 
especially after scarlatinal kidney disorder — in some an interval 
of comparative health had supervened, but after a time an icte- 
rode hue assumed the place of the natural complexion, with a 
certain puffy appearance, leading the parents or a common ob- 
server to think indicative of increasing flesh. If the kidney had 
been damaged, the violence of the convulsions by their contin- 
ued succession, acts in a doubly dangerous manner — in the first, 
by the exhaustion, and in the second by the extra amount of 
animalized matter that is thrown into the circulation, and which 
cannot be voided by the natural emulgent channel of the kid- 
neys. As in chorea, where the muscular movements are exces- 



1858.] Catamenial Gonorrhoea and Syphilis. 63 

sive, the sulphates as well as urea will be found in excess in the 
urine r evidencing the rapid waste of muscular structure, by the 
inordinate movements during convulsions. — \_Am, Med. Monthly, 

(To be continued.) 



Lecture. — Catamenial Gonorrhoea and Syphilis. 

Mr. Frederick C. Skey, Surgeon to St. Bartholomew's Hos- 
pital, has recently lectured on Gonorrheeal Rheumatism. The 
London Medical Circular gives us the lecture, from which we 
make the following extract, bearing upon a point of great inter- 
est : 

I saw some time ago another most remarkable case of this 
kind — the splitting in pieces of a family might have occurred 
from the raillery and ignorance of the hospital surgeon, but he 
could not see it. A respectable-looking married man came with 
this catamenial gonorrhoea ; he was very much puzzled about 
it, but the surgeon laughed at him. "So ho, my find friend," he 
said, "you've simply gone and done it; you've been with the 
girls." The man said not — that from the nature of his business 
it was impossible. " Then some onehas been with the girls or 
with your wife, for you have the bad disorder— that's the short 
and long of it." The man protested, till at last he swore an 
enormously large oath at the ignorance of us all. " Why, I have 
committed as many crimes as many men, and why should I be 
such a fool, if I wished to be cured, as to say, if I had, that I 
had not had intercourse with a woman." I don't believe he had, 
but that it was one of the dozens of cases where the irregulari- 
ties of married life had given rise to a gonorrhoea, or blenhorr- 
hcea, that I defy you to distinguish from common gonorrhoea, 
I say there is a "tertium quid engendered during the period 
of ovulation or menstruation in the female, that may give rise 
to gonorrhoea, but I do not believe in syphilitic inoculation. If 
you know how to treat rheumatism, you know a great deal also 
of this disease. Mr. Abernethy, as I said, already went to the 
threshold on the subject, as regards "rheumatic gonorrhoea," or 
what you will see copied in the books and manuals as gonorrheeal 
rheumatism. Evans and Rose and Hennen, away from the 
coteries of London, settle the thing forever. You are probably 
aware, the prostitutes in France are all examined at stated times,, 
and are furnished with clean bills of health ? Well, Evans saw 
several hundreds of these women examined, and only three 
were diseased ; but he had one hundred and fifty-three soldiers 
under his care at that moment with syphilis ! I say, how did 
these 153 soldiers become diseased from three women ? How 
did they get it ? Where was it to come from ? To my mind,- 
now, it is as clear as that chloroform will produce insensibility, 



64: Catamenial Gonorrhoea and Syphilis. [January, 

or any other fact in surgery ; they got it from the clean women, 
and not from the diseased. I told you of Torres Yedras. This 
army was inaccessible for a long time, and dozens of officers had 
intercourse with the couple of girls dancing at the theatre. 
These girls, mind you, in good health, yet shoals of these officers 
came to England with bad phagedenic sores. Do you think 
they got phagedene directly, as Mr. Hunter would think, from 
these girls ? I don't. 

Well, I'll tell you another case, and within a very short 
period of the present — not to go back to Torres Vedras or Wa- 
terloo, or tire you with what you will find decked out in the books 
of the schools — the case of a lawyer. [I am glad it's a lawyer, if 
it must be somebody (laughter ;) lawyers are so wedded to do 
nothing, if erroneous, to the decision of their judges.] It was, 
in a word, the counterpart of the first case— seduction, love (the 
old story) — seduction, gonorrhoea and a crop of sores. I exam- 
ined the lady with the utmost minuteness. I sifted this case 
carefully. I believe there was no disease whatever in the lady 
nor in the gentleman previous to the occurrence ; yet all the — 
what shall I call it — legal evidence was the other way. Legal 
proof on medical subjects at present is the greatest absurdity 
Under Heaven, because Well bound books on surgery say one 
thing to a man with a wig and gown on, and because a sur- 
geon's opinion which is not only viva voce and original, but fair- 
ly worked out after thirty or forty years' analysis of facts and 
cases in hospitals, must be thrown to the winds, in favor of the' 
dictum of some old book, or some new book copying the old. 

I say, this material syphilitic infection is all a fallacy, I don't 
believe either in all that black letter lore of syphilis coming from 
St. Domingo with Columbus in the fifteenth century. Gonor- 
rhoea is detailed in our oldest and most sacred of books. 

Mr. Skey next stated the particulars of a very interesting case 
—a case of most frightful phagedenic sores in a gentleman, like 
those of the officers sent from Lisbon, but where the disease was 
clearly the result of scrofula, or some such constitutional taint in 
the gentleman's system aggravated by those injudicious courses 
of mercury, ordered for a very simple affection at first. The case 
was one, also, where the nymen was ruptured for the first time, 
but not a trace of disease existed in the lady. 

"This old mercurial school, however, still holds out," Mr. 
Skey continued to say ; "I am sorry that even men like Sir B. 
Brodie still belong to it. It is not true that a woman who will 
allow one man to her embraces, will allow any other ; and if the 
disease be checked by mercury — -post hoc, &c. — that we should go 
on giving it ! In this last patient it made all this difference, that 
whereas Eose, or Evans, or Carmichael would have cured this 
gentleman without mercury, in following the plan of the older 



1858.J Treatment of Primary Syphilis. 65 

schools he was at the point of death, owing to the mercury, 
under the first advice in London, affecting the membranes of 
his brain. We shall not speak of the hideous mutilations of 
face and nose, the time sacrificed away from business on the sick 
list, and the marks which rupia too often leaves on the forehead 
and face, I am satisfied, and you will be so too, when you see 
some practice, that all this old-fashioned dosing system with 
mercury is bad. I would almost go so far as to say, that the 
very worst cases of syphilis, so called in men that I have seen, 
have been the result of something wrong with the man rather 
than the woman, and where the "tertium quid" was aggravated 
by this system of giving mercury, as a piece of murderous old 
routine in all cases alike. 

Well, a few words now as to gonorrhoea and rheumatism. Is 
there such a thing as spontaneous gleet? Yes; it is a catarrh 
of the parts. I know a gentleman who has had gleet ; but he 
has been several months, aye years, in bed for another disease, 
and he had no possible manner of getting gleet. 

You will find gonorrhoea! rheumatism in excentric gonorrhoea, 
mostly in oldish people, the disease mild or the opposite, fond of 
fits and starts or aberrations ; it is gonorrhoea in a rheumatic sys- 
tem, but not rheumatism connected as a secondary symptom or 
as cause and effect with gonorrhoea. I am satisfied, gonorrhoea! 
rheumatism and gonorrhoea are children of one parent, and not 
related as rheumatism the child of gonorrhoea, the parent, 

I will now tell you more: I have seen every form of syphilitic 
disease as obtained from healthy women. These cases occur in 
the better ranks of society, with men who are above suspicion. 
"What is sometimes shocking in a moral point of view, is of the 
utmost value to us pathologically. But I must not dwell on 
these cases. The gentlemen come to me expressing their un- 
bounded astonishment, yet if you make the most careful search, 
even with the speculum, there is no disease in the lady ; it would 
be almost a relief to one's mind to find something, but there is 
no disease whatever. No, it is all fallacious. — [Ohio Medical and 
Surgical Journal. 



Treatment of Primary Syphilis hy Preparations of Iron. — Xtfcord sug- 
gested the employment of potassio-laetate of iron in phagenic chancre, 
and Mr. Acton recommends it very highly. Mr. Behrend (Lancet), be- 
lieving in the essential identity of the virus of every form of chancre, and 
attributing the apparent differences to special circumstances, was led to 
employ this preparation of iron in the treatment of the common chancre. 
He reports the details of a number of cases thus treated, with the most 
satisfactory results. His method of administering the iron, is to make a 
mixture of one ounce to six, of which two teaspoonfuls are to be taken 
three times a day. The local applications are simple. — [Med. Independent 



66 Editorial [January, 



EDITORIAL AND MISCELLANEOUS. 

The Fourteenth Volume, of the New Series, of the Southern 
Medical and Surgical Journal. — In presenting the first number of the' 
fourteenth volume of this Journal to our readers, we would call their 
attention to the enlargement of the work, which, by the liberality of the 
pulisher, presents to the subscriber as large an amount of valuable read- 
ing matter, as any similar work, at the same price, in the country. 

Having its circulation principally in the Southern and Western States,- 
we have endeavored to embody in each number of the journal, such 
original and selected matter, as our own judgment and the advice of our 
more experienced colleagues have indicated to be most valuable for the 
exigencies of the Southern Practitioner. No new principle in medicine, 
no new view of pathology, or rational mode of treatment, has met our 
eye, throughout the whole range of our fifty or sixty exchanges, Domes- 
tic or Foreign, but what we have endeavored, so far as we had space, to 
treasure up in our pages for the benefit of our readers. This we 
shall still do, so long as our connection with the work shall con- 
tinue. Having been in long and intimate relations with a large number 
of Physicians throughout the country, we have, we hope, acquired a 
sufficient knowledge of the wants of the Soul hern Practitioner, to pre- 
pare for him a useful and efficient journal. We are aware that the 
thirteenth volume of the Southern Medical and Surgical Journal, will be 
found deficient in some of the departments of Medical Literature ; thus 
in the department of Reviews, our estimation of the true intent and ob- 
ject of a monthly journal has induced us not to occupy our space with 
extended analyses of works, unless in so doing we could embody views 
and suggestions, of a practical nature, for the benefit of the reader. We 
have given each work, sent us by authors and publishers, a diligent and 
careful examination, and, when found worthy of recommendation, have 
given it our approval, or we have carefully pointed out its defects. We 
look upon the department of Reviews as belonging more particularly to 
the Quarterly and Bi-monthly journals, one of which, each member of 
the Profession should subscribe for, but in no case, to the exclusion of the 
monthly journals ; for in these last he finds the supply for his daily, and, 
indeed, his hourly necessities. " Knowledge (says a distinguished writer) 
evaporates like water ; and as the ocean itself, unless replenished, would 
become empty, so the brain, unless its avenues to improvement are kept 
open and well trodden, becomes but a barren waste, haunted by the 
ghosts of worn-out and obsolete thoughts :" — a fatuous and somnolent 
demain, a " Sleepy Hollow" and its occupant a veritable Rip Van Win- 



1858.] Editorial 67 

tie — dozing while the whole world has been advancing — his mental 
status being the index to its condition just twenty years gone by ! 

In making these remarks, of course, we have no fear of giving offence, 
for none from this sleepy region will ever be offended by these distaste- 
ful animadversions, for what is written, is for them, u as though it never 
had been writ." 

The volume of our journal, just now commencing, will, we hope, be- 
sides the liberal enlargement by the publisher, present an increased 
interest to its readers, in the many valuable original papers now in prepa- 
tion for its pages. We have also on hand, lignographic illustrations of 
several interesting articles, which are intended to embellish the work 
and add to its value. 

We continue to invite contributions from our brethren, and with their 
countenance and support, we enter upon the labors of this fourteenth 
volume with that hope and confidence, which, a determination to do our 
duty, alone can inspire. Henry F. Campbell. 

Robert Campbell. 



Materia Medica and Therapeutics : with ample illustrations of Practice 
in all the departments of Medical Science, and very copious Notes of 
Toxicology, suited to the wants of Medical Students, Practitioners, and 
Teachers. A new edition, revised and enlarged. By Thomas D. 
Mitchell, A. M., M. D., Professor of Materia Medica and General The- 
rapeutics in Jefferson Medical College, and formerly Professor of 
Chemistry, Materia Medica, and Theory and Practice in the Medical 
College of Ohio, Transylvania University, and the Kentucky School of 
Medicine ; Author of u Elements of Chemical Philosophy," &c, &c. 
Philadelphia: J. B. Lippincott & Co. 1857. 8vo., pp.*820. (For 
sale by T. Pachards & Son.) 

This last edition of Professor Mitchell's work has been brought up to 
the very last hour of the Science of Therapeutics. Every thing new per- 
taining to the subjects under discussion has been collected from journals 
and books to enrich this volume ; and yet it is neither cumbrous, un- 
wieldy or expensive. We regard it as perhaps the most practical of all 
the treatises on its special subject. This work perhaps would not answer 
as the sole treatise of Therapeutics possessed by the Practitioner, nor do 
we know any work that would ; but the neglect of the practical good 
sense and honest labor stored away in its pages will deprive the Physi- 
cian of some most valuable suggestions and expedients. 

In the miscellany of the present number of our journal will be found a 
simple test for Quinine and morphine. We select it for its practical va- 
lue and convenience, and also as a specimen of the many treasures gar- 
nered up in Dr. Mitchell's book. The style of the work does much credit 
to its publishers, Messrs. J. B. Lippincott <fe Co. 



68 Editorial. . [January, 

A Dictionary of Medical Science ; containing a concise explanation of 
the various subjects and terms of Anatomy, Physiology, Pathology, 
Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, 
Medical Jurisprudence, Dentistry, etc. ; Notices of Climate, and of 
Mineral Waters ; Formulae for Officinal, Empirical, and Dietetic Pre- 
parations, etc. ; with French and other Synonymes. By Robley Dun- 
glison, M. D., LL. D., Professor of the Institutes of Medicine, etc., in 
the Jefferson Medical College of Philadelphia. Revised and very great- 
ly enlarged. Philadelphia : Blanchard & Lea. 1857. 8vo., pp. 992. 
(For sale by T. Richards & Son.) 

Professor Dunglison — the Samuel Johnson of Medical nomenclature — 
lias brought forth the Fifteenth Edition of his great work, " The Medical 
Dictionary." 

The above announcement speaks volumes ; a good reliable dictionary 
is a necessity which admits of no choice; we may neglect other depart- 
ments of Medical literature, but the words, " the vesture of our thought," 
must be at our command, or we must be dumb. The number of editions 
through which this work has passed indicates its appreciation by the 
Profession. The labor bestowed on this last edition is immense, and 
speaks well for the industry and power of research of its distinguished 
author. In its style and typographical excellence Messrs. Blanchard & 
Lea fully sustain their well established reputation as publishers of medi- 
cal works. 

Lectures on Diseases of Women. By Charles West, M. D., Fellow of the 
Royal College of Physicians ; Examiner in Midwifery at the Royal Col- 
lege of Surgeons of England ; Physician Accoucheur to St. Bartholo- 
mew's Hospital, and Physician to the Hospital for Sick Children. 
Part I. — Diseases of the Uterus. Philadelphia : Blanchard & Lea. 
1857. 8vo., pp. 316. (For sale by T. Richards & Son.) 

We have given the above work a careful examination. We are familiar 
(as who is not?) with the previous writings of Dr. West, and all we 
know of them speak much in favor of the present treatise. A fairer, 
more honest, more earnest, and more reliable investigator of the many 
diseases of women and children is not to be found in any country. His 
own Preface will give a better idea of the intents and objects and uses of 
the book, than any exposition of ours. We therefore quote briefly : 

" These Lectures are a first instalment towards the discharge of that 
debt which the opportunities of a hospital, and the responsibilities of a 
teacher, impose upon me. A second volume, which will treat of all the 
remaining diseases of the female system, will appear, if health and strength 
are spared me, within three years from this time. I have published this 
part separately, because I believe that students and junior practitioners 
stand in much need of that help which, with reference to an important 
class of these ailments, it may perhaps afford them." 

For the Student and junior Practitioner the work has been particularly 
prepared, and to this class we would earnestly commend it. 



1858.] Editorial. 69 

A Case of Excision of the Hip Joint for Morbus Coxarius, with remarks 
upon the pi'opriety of such an operation, and a summary account of the 
recorded cases up to the present time. By R. A. Kinloch, M. D., Sur- 
geon to the Roper Hospital, and Lecturer on Surgery in the Charleston 
Summer Medical Institute. 

This valuable paper, sent to us by our friend, the author, has been 
upon our table for some time, but by some mischance overlooked. It 
details an operation by the reporter, which, though unfortunate in its 
result, constitutes a valuable record in this department of operative sur- 
gery. The value of the paper consists in the research made by the author 
and the bringing together of a number of cases, with their peculiarities 
and their results. This he has done in a tabular form, so that the main 
points of each case are conveniently presented to the reader. "We com- 
mend the article to all those who are interested in cases of Morbus 
Coxarius, and to all who wish to become familiar with the statistics of 
the operation of Excision of the Hip Joint. 



Books received for Review. — Besides the works noticed in our 
present number, we have received from Messrs. Blanehard & Lea the 
following : 

" Dunglison's General Therapeutics and Materia Medica. Sixth edition, 
revised and improved." 

M Peasley's Human Histology :" a new and valuable work, to be noticed 
in our next number. 

From Messrs. Lindsay & Blakiston — 

" MendenhalPs Students Vade Mecum. Fifth edition, enlarged and 
improved." 

" A Practical Treatise on Diseases of Women and Children. By J. 
Forsyth Meigs. Third edition, carefully revised." 

From Messrs. J. B. Lippincott & Co. — 

"Essays on the Secretory and the Excito-Secretory System. By 
Henry F. Campbell, M.D." 

The above works came to hand too late for a careful notice ; they 
shall meet with full attention in our February number. 



Atlanta Medical College — Resignations and Appointments. — 
Professors Boring and Means have resigned their respective Chairs of 
Obstetrics and Chemistry in the above Institution. 

To fill the vacancy caused by the retirement of Professor Boring, Dr. 
T. S. Powell, of Sparta, has been appointed by the Trustees ; we hope 
that the Institution will be able to secure as able a successor to Professor 
Means. 

Dr. Means retains his connection as Professor of Chemistry with the 
Medical College of Georgia. 



70 Editorial and Miscellaneous. [January, 

Binding of Thirteenth Volume. — We would suggest to our readers 
the binding of their volumes of the Journal, thus adding a book to their 
libraries, instead of having their tables cumbered with twelve perishable 
pamphlets, which must soon disappear from their possession. 

Discriminating Test for Quinine and Morphia. — Although the 
following is in a book, which all our readers should possess, on account 
of its simplicity and importance, we record it prominently in our ex- 
tracts : 

" As mistakes have been made, and may be again committed, in con- 
founding sulphate of morphia with sulphate of quinine, it is important to 
distinguish accurately. The labels may have been rubbed from the bot- 
tles, and it would not do to rely on taste or smell. Both salts are bitter, 
but one is decidedly poisonous. If we add a drop or two of strong nitric 
acid to small portions from each bottle, placed on a watch-crystal, the 
quinine salt will be made yellow, while the salt of morphia will be 
changed to a bright red. The experiment is performed with ease, and 
is sufficiently accurate for practical purposes, and every physician should 
keep the test in his mind." — [MitchelVs Materia Medica, last ed. y p. 324. 



Sympathetic Inflammation of the Eyeball. — Mr. "Walton remarks 
(British Med. Journal), that the horse doctor is in advance of the accom- 
plished ophthalmologist in their knowledge of some diseases of the eye. 
It has been a practice among farriers, in certain ophthalmic diseases of 
the horse, to destroy the eye by suppuration, knowing well that the 
other eye, which is in great peril, could be saved by this means. Mr. 
Wardrop, taking advantage of this hint many years since, practiced 
evacuating the humor of the affected eye, and thereby relieved the sound 
organ from the dangers of a sympathetic inflammation. 

[This has been the uniform practice of Professor L. A. Dugas, of this 
College, for years, and we believe it is a measure now very generally 
adopted by surgeons in such cases.] — Eds. S. M. & S. Jour. 



Oil of Tansy. — Dr. Chapin, of Winchester, introduced (to the notice 
of the Middlesex East District Medical Society, Nov. 4th, 1857) the sub- 
ject of oil of tansy in its ecbolic and toxicological relations, and related a 
case in which he was summoned at midnight to visit a married female, 
" in a fit." The patient was found in bed, partly conscious, and in par- 
oxysms. A distinct smell of the oil pervaded the apartment. Vomiting 
had occurred. He immediately exhibited ipecacuanha and sulphate of 
zinc, which was followed by free emesis. In an hour the mind became 
clear and she got along very well. The woman was four months advan- 
ced in pregnancy, and took the oil for abortion. The quantity taken 
was half a fluid ounce. Dr. C. stated that some cases have been fatal. 

Drs. B. Cutter and Drew, of Woburn, adduced similar cases, and Dr. 
Underwood, of West Cambridge, spoke of a young woman in a hotel 



1858.] Miscellaneous. 71 

who took the oil to procure abortion. The immediate effect was violent 
convulsions. At full term a child was born, not larger than a rat. The 
child lived three weeks. This case was mentioned to show that the oil 
sometimes arrests growth. Dr. Toothaker, of Wilmington, spoke of a 
middle-aged married woman who took two fluid ounces of oil of tansy 
in divided doses without effect. She then resorted to the woods, al- 
though it was midwinter, and the snow knee-deep, and gathered a quan- 
tity of savin leaves, an infusion of which was freely taken without success. 
At term, she bore a medium-sized child, which for some time was esteem- 
ed non compos. Now, however, at the age of ten, the child is a bright 
boy. 

Oil of Cedar. — Dr. Ingalls, of Winchester, spoke of the exhibition of 
half a fluid ounce of oil of cedar, which was followed by nausea and 
fright. The girl took it for an emmenagogue. Dr. Hodgedon, of West 
Cambridge, said he attended a woman who had been in convulsions 
three or four hours on taking cedar oil. After an emetic she recovered, 
with no ill effects. The patient was chlorotic, and dosed for amenor- 
rhcea. Dr. Underwood asked if the use, by midwives, of an infusion of 
raspberry leaves, in place of ergot, was known to the Society. Drs. B. 
Cutter and Drew had found draughts of cold water useful to increase 
pains, and allowed their patients a free use of the article during labor, 
Dr. Toothaker inquired if the uva ursi wonld act as ergot. In one case 
he used the infusion very freely, with no effects. On exhibiting a moder- 
ate dose of ergot, contractions immediately ensued. — [Boston Med. and 
Surg. Journal. 

Colica Pictonum produced by the White-lead Treatment of a Severe 
Scald. — Dr. G. A. Kunkler relates the case of an Irish servant girl, who 
severely scalded the fore-arm and hand. Extensive vesication followed. 
The blisters were punctured, and common white paint, of the consistence 
of cream, was freely applied with a camel-hair brush, the part was covered 
with cotton and a roller applied over the whole. This dressing was re- 
peated on the following day. On the third day she exhibited unmistaka- 
ble signs of colica saturnina — acute abdominal pain, retraction of the 
umbilicus, constipation, and slight discoloration of the gums. The symp- 
toms yielded to opium and purgatives, and the linseed-oil and lime-water 
dressing was substituted for the lead, under which treatment the burn got 
well. Dr. Kunkler states that he has freely used the white paint in a num- 
ber of other cases, some of them of great severity, without meeting with 
a bad result. The editor believes this to be the only well-authenticated 
case of colic resulting from the application of white lead to burns or 
scalds. — [Medico- Chirurgical Review. 

On the Physiological and Toxicological Properties of Woorara. — M. 
Pelikan has communicated to the Academy of Sciences the results of his 
experiments on woorara poison. With regard to its physiological effects, 
the author arrives at the same results as M. CI. Bernard. As to its toxico- 
logical action, M. Pelikan finds that an aqueous solution introduced into 
the stomach by an elastic tube produces poisonous effects, but more slowly 
and less energetically. This cannot be explained on the supposition that 
woorara contains a certain quantity of serpent-poison, for it is characteristic 



72 Miscellaneous. [January, 

of nearly all the narcotic poisons which are easily absorbable. Curarine 
possesses all the active properties of woorara. Five centigrammes of the 
alkaloid introduced under the skin of a rabbit caused death, with all the 
symptoms of poisoning by woorara. When woorara is absorbed in a suffi- 
cient dose to produce death, there can be no question as to the antidote. 
Strychnia can provoke its peculiar symptoms only in the case where the 
dose of woorara has been insufficient, and vice versa. Solution of woorara 
precipitated by tannin loses its effect in an ordinary dose, but in powder 
mixed with powdered tannin, and introduced into a wound, it preserves its 
poisonous action. The action of the poison is not destroyed by iodine dis- 
solved in iodide of potassium, neither in the case of the two solutions mix- 
ed, evaporated, and the residue introduced into the subcutaneous tissue. 
[Archives Generates, and Brit. <£ For. Med. Rev. 

Pulmonary Epithelium. — In the July number of the British and For- 
eign Medico-Chirurgical Review, we notice an article by Dr. C. Radclyffe 
Hall, on the epithelium of the air vesicles of the human lung. 

Some of our readers may recollect a paper by Dr. Hall in the last Oc- 
tober number of the Review, in which he states that in chronic pulmonary 
consumption, " fatty atrophy of the epithelium of the air vesicles is ante- 
cedent to the formation of tubercle ; in the same number we have a paper 
by Mr. Rainey, against the existence of epithelium in the air vesicles. 
This paper by Dr. Hall assumes to demonstrate these epithelial cells, and 
is illustrated by wood cuts of their microscopic appearance as seen by 
Dr. Hall and Dr. Brittan. Assuming that these illustrations are correct, 
and we have no reason to doubt it, there seems no doubt but that epithe- 
lial cells can be demonstrated in the human lungs, and the lungs of the 
mammalia. We cannot but agree with Dr. Hall, that on a question of 
relative authority, " the positive evidences of one trustworthy observer is 
usually allowed to overrule the negative evidence of many." An exam- 
ination of this article by Dr. Hall, with the drawing of the microscopic 
appearances by Dr. Brittan, will not fail to convince any one of the exist- 
ence of epithelium in this situation. If this were not the fact, the state- 
ment of Dr. Hall that fatty degeneration of the epithelium of the air cells 
preceded the deposition of tubercle, (an observation which we conceive 
to be of value, and which we hope may be further elaborated,) would of 
course be entirely without foundation. — [Buffalo Med. Jour. f. 

Treatment of Anatomical Wounds with Lotions of Chlorine Water. — 
M. Nonat, Physician to the Hospital of La Charite, recommends the use 
of lotions, with solution of chlorine, in cases of anatomical wounds, which 
unfortunately are far from being always exempt from danger. Be the 
wound large or small, be its surface united or unfractuous, the solution of 
chlorine destroys the putrid matter, which acts like a virus, and which 
causes so bad an influence on the system when absorbed. This agent 
may perhaps be absorbed, mix itself with the blood, and thereby prevent 
the mischief arising from them, or destroy those bad symptoms which 
have already appeared. 

The way to use it is very simple. The wound is first well washed with 
water, then with the solution of chlorine. If the wound is one of some 
days' standing, if it is inflamed, if the lymphatic vessels and glands are 



1858.] Miscellaneous. 73 

obstructed, if the general appearance is favorable, and provided there are 
no symptoms of putrid infection, — the lotions of chlorine may arrest 
these accidents. It is useful in these cases, to use at the same time inha- 
lations of chlorine. 

M. Xonat has often had opportunities of testing these means, and in 
very serious cases. He thinks chlorine ought to be put at the disposal of 
the students, in the dissecting halls, and would have the following in- 
scription upon the walls of the amphitheatre — "Wash, as soon as possi- 
ble your anatomical wounds with solution of chlorine." — [ Union Medicalc, 
and Medical Circular. 



Cod-Liver Oil Solidified with Gelatine, — Take of pure gelatine, half 
an ounce ; water, simple syrup, of each four ounces ; cod-liver oil, eight 
ounces ; aromatic essence, as much as may be sufficient. Dissolve the 
gelatine in the boiling water, and add successively the syrup, the oil, and 
the aromatic essence ; place the vessel containing the entire in ysmal fever 
alone. 

It hence does appear, that quinine, in any disease depending 
on spinal irritation, probably acts by dispersing the cause of that 
irritation, whether active or passive hyperemia in the spinal 
c-:r:I — ini :lerel~ rriiiTrS :he ^eirril r-fsil:az: :•: :: lirion. Tie 
explanation which we would offer for these phenomena is the 
following : 

When quinine is given only during a paroxysm of fever, no 
opportunity is allowed for the display of its power over the 
distended, congested or excited vessels; for the universal vascu- 
lar excitement which pervades the organism, with the heart's 
i-:Tz.ml :.i-;. m::- ::r:i:le a::::- rnniiing iLe :i:-:-i in ~r:n 
these, already surcharged local vessels, and maintaining or 
increasing their derangement, the display of its powers is pre- 
vented, its effects are canceled. Hence, it is only during the 
absence of fever, unle^ extraordinary doses are employed, when 

'. issi&taiioa of Febrile Diseases, 9 by their Eelasion to the >~erroa» 
m, in Introdoetion to xoiiame oa "The Secretory mad EmJUhSeerete: 
tern." By Henry F. CampbdO^lL D. r ju5t pohtished. 



80 Campbell's Lecture on Dysentery. [February, 

it has not these opposing influences to contend with, that it 
readily overcomes the local condition, and thus suspends its 
symptomatic results, 

So, may it be perceived, that in the treatment of Dysentery, 
quinine forms necessarily an essential element — we had almost 
said, without the single exception of a case — for in those instances 
unaccompanied with fever, if they do not yield promptly to 
that management, of which this does not consitute a part, we 
believe, that by acting upon the idea of its spinal basis, in ac- 
cordance with our previous pathological suggestions, its addition 
to the course would be acknowledged the desideratum in almost 
every case, 

We are aware that, as regards the employment of this agent 
unorthodoxly, or otherwise than for "chills and fevers" there is 
Borne opposition on the part of the community, who, consulting 
their own prejudices will, through intentional and covert neglect 
of the strictest injunctions, cause the failure of its object, to the 
serious detriment of the patient's safety and the physician's re- 
putation. We know also — and the knowledge is humiliating 
in our climate, where almost all acute diseases appear to be im- 
pressed with the type of periodicity more or less decidedly — • 
that there are members of our own profession, (charged as it is 
with so awful a responsibility — the arbitership of human life,) 
whose minds being impregnated with the spawn of that popular 
medical doctrine, above alluded to, or from some ill-begotten 
prejudice, or some ill-fated notion, legitimately inherited, per- 
haps, from some outlandish Alma Mater,— some we say, who 
look upon this invaluable and indispensable remedy, as "danger- 
ous," something not far short of a poison, and therefore fail to 
see its applicability to disease, or use it so daintily, as not to 
allow themselves the opportunity of witnessing its efficacy; 
whilst the devoted patient, deluded and lulled by the semblance 
of a systematic course of attack being made upon the disease, is 
cheated by periodical gradations into irrevocable ruin — the 
malady still raging with increasing fury against him, with every 
reinforcement of its morbific armament— the returns of fever 
with the accompanying increase of all the other ills — derived 
from its cerebro -spinal ally — until life " is sunk amid its foes." 
Such is an unfortunate prejudice, and melancholy have been its 
results — for which the lives of many patients have doubtless 
been made to atone. 



1858.] Campbell's Lecture on Dysentery. 81 

But what argument shall we employ against that stubborn 
stupidity which, in this late day, still questions the right of this 
agent to hold the rank it does in the Materia Medica ; or what 
logic can avail to assure that doubting pusillanimity which yet 
does not dare, or affects to fear, to use this remedy in efficient 
quantity, after the mammoth, though innocuous doses, of Mail- 
lot, of Dundas, and of others. Let such seek the first opportunity 
by experiment upon his fittest subject, to divest himself of so 
dangerous and criminal a delusion. Yes, let him take 40 grains 
of this poison at one dose, (as we had occasion to administer to 
a forlorn case of congestive fever, which actually recovered,) and 
if he does not die, he will be convinced of its harmlessness, but 
if he does — well then, his patients in this region will stand the 
better chance for living. We would not have you, Gentlemen, 
to understand us to recommend such doses in ordinary practice, 
as they are unnecessary ; for remember, that the two cases, (both 
that of the doctor and that of the more pitiable patient,) here 
coupled, are of a desperate type. — But what we say is ; give 
Quixine in Dysentery ! 

The most important and efficient adjuvant in the treatment 
of that element of the disease, embraced in the condition of the 
great nervous centre, is manifestly to be found in the applica- 
tion of revulsives along the spinal column ; dry cupping and 
sinapisms, or if any portion of the cord is discovered to be de- 
cidedly irritable, by acute sensitiveness on pressure upon the 
corresponding spinous processes, it may be necessary to resort to 
vesication or to cupping with the abstraction of blood. TVe 
have known the whole aspect of affairs in a case, wherein un- 
controlable tenesmus was a very threatening accompaniment, to 
be most astonishingly improved by the application of a blister 
to the lower part of the spine. 

So much for the consideration of the remedial means, which 
are necessary for the relief of the cerebrospinal ingredient of this 
disease ; let us examine now into the demands of the other ex- 
isting condition — that of the large intestine. These are com- 
prised in the 2nd and 3rd indications, which may be treated of 
in connection — the latter being in this instance, involved in, 
and forming a necessary condition to, the former — that is, 
whilst the mucous membrane, here, requires the treatment 
appropriate to mucous membranes elsewhere, — here, it is besides 



82 Campbell's Lecture on Dysentery. [February, 

the lining of an excretory canal, which conveys a material of 
more or less solid consistence ; therefore, it is also necessary to 
combine with that specific treatment, some peculiar method of 
procedure to prevent the irritation of the contained solid excre- 
ment, in its transit through the inflamed canal— since it must 
pass through; and this is best accomplished by reducing its 
consistency from a solid to a fluid state, preventing its accumu- 
lation and solidification, and also, by shielding the sore surface, 
if possible, with some emollient or soothing application. These 
two indications, then, together with derivative measures, com- 
prise the treatment of the local or intestinal element of this dis* 
ease. 

Now, let us examine briefly into the rationality of a few of 
the most prominent among the various measures which have 
been proposed and are much practiced, for the relief of Pysen^ 
tery, the accomplishment of which can alone be attained, we 
conceive, in accordance with the specifications just laid down, 
whatever be the means put into requisition, for their fulfillment 

The procedure which we have designated the M Opiate and 
Astringent routine," or the system of giving, indiscriminately, a 
specified quantity of some opiate and astringent compound, a£ 
ter each discharge, mistaking them for passages, in order more 
fully to clog up the bowels, cannot be too severely reprehended, 
as it is indicative of pure ignorance or an entire misapprehend 
$ion of the nature of things, and is in this instance attended 
with no ordinary amount of pernicious result. For the adminis- 
tration of astringents, there can be found no shadow of excuse — . 
their avowed attribute, being their capability of inducing, just 
that condition which already exists as the chief difficulty in Dys» 
entery, and which should be one of the prime objects of the 
physician, speedily to overcome. But the demand for opiates, 
in view of their anodyne effect, is rather more plausible, as this 
disease is attended with much suffering, and the unwary and 
irresolute might perhaps be decoyed, through so urgent a plea, 
into disregarding the admonitions of his better judgment, for 
the sake of temporary respite, at the expense of radically in- 
creasing the difficulty, even to fatality, or delaying in so much, 
the fortunate termination of the case. This, Gentlemen, has re- 
ference to the error of giving opium systematically, as a part of 
the radical treatment of Dysentery, in the same manner that 



1858.] Campbell's Lecture on Dysentery. 83 

diarrhoea is treated by it — and here let it be well understood, 
that with this object, opium is never indicated in this disease; 
because there is constipation already existing as an element of, 
and a very serious aggravation to it — and also as, very unfortu- 
nately, one of the most prominent effects of this agent, is to 
induce or increase that very same^condition, But, although 
opiates are not admissible, as part and parcel of the regular treat- 
ment, yet there are frequent circumstances under which their 
pro re nata employment is demanded for another purpose — that 
of procuring rest and sleep, notwithstanding their very incon- 
venient and pernicious quality, here obtaining, of suspending the 
peristaltic action of the intestine, and thus increasing constipa- 
tion ; which effect has to be guarded against and overcome, by 
the unremitting pursuance of some procedure which will prevent 
or neutralize this deleterious influence, by keeping the bowels 
in a relaxed condition— that procedure, fortunately, being the 
proper and only appropriate treatment, under this head, for Dys* 
entery, as has been indicated and will be further shown. 

The secondary position assigned to this agent then, will be 
found to be in the fulfillment of another and far different indi- 
cation ; not in the treatment of the disease itself, but for the relief 
of some of the untoward evils consequent upon the disease, and 
will be noticed in its proper place. And it is to be esteemed a 
great misfortune, in reference to this class of remedies in this 
disease, that their valuable anodyne effects cannot be put in 
requisition, except at the expense of enhancing the diseased 
condition, through the consequent evil of their constipating ef- 
fect. Hence, you perceive, that the M opiate and astringent" 
treatment is worse than no treatment in the end — that in fact, 
the disease demands the reverse interpretation, to what is here 
evident, as the basis of an opposite treatment. 

The practice with Cold-water or other soothing enemata, cannot 
take the place of treatment in Dysentery, but is valuable as an 
adjuvant in some cases, to allay irritation. This subject has been 
treated of at length, by Dr. Brown of Alabama, who in regard to 
it, employs the following extravagant language, viz., u I will 
now briefly consider the superior advantages of the Cold Water 
Treatment, as pursued in the foregoing cases, and particularly 
its topical application by enemata. The immediate effect of its 
introduction is remarkable — the patient generally expressing 



84 Campbell's Lecture on Dysentery. [February, 

entire relief from the pain and burning sensation, which suspen- 
sion of suffering lasts for a considerable time. Thus, in its 
anodyne effect, surpassing, by promptness and completeness, all 
the ordinary means. The nervous irritability which is excited 
in these cases, with nausea and intense thirst, especially in fe- 
males, and the high febrile excitement, yield equally to its 
sedative and cooling effects. The evacuant and cleansing proper- 
ties of the measure, are unsurpassed by purgatives, and without 
the danger of reducing the patient by hypercatharsis or inter- 
ference with nutrition. While hydragogue cathartics may re- 
duce the inflamed condition, by a draught upon the turgid 
vessels of the part — the cold application, by a more economical 
process, would suppress the inflammatory action, by contracting 
these distended vessels, driving out their superabundant blood, 
and fortifying them against a continuance of the phlogosis." 

Dr. B. recommends two modes of applying cold water in Dys- 
entery : — 1st. By towels, wrung out of the coldest water, kept 
constantly to the abdomen, and renewed as often as they assume 
the temperature of the body ; and, 2ndly, by the introduction 
into the bowel, with a syringe, of a pint of cold water, after each 
dejection. The suggestion is certainly a rational one, having 
afforded much comfort to the patient, under our own observa- 
tion ; and it is worthy of being borne in mind, to be brought 
into requisition, to quiet the excessive irritation in the bowel, 
inducing frequent tenesmus, as an accessory to the treatment of 
some cases, where there is present no contra-indication. 

The Mercurial practice has been recommended according to 
two different modes of application, for the accomplishment of 
two distinct objects — viz: 1st. By the repetition of large doses 
of calomel or blue mass, for the purpose of effecting continuous 
mercurial purgation. 2nd. By the administration of small doses, 
combined perhaps with some opiate, Dover's powder most fre- 
quently, with the view of inducing ptyalism — on account of the 
supposed virtues of that condition, in controlling inflammation. 
Now, we conceive the wholesale administration of mercury, in 
any disease, to be an unnecessary and unwarrantable procedure — 
as also is the indiscriminate and unscrupulous subjection of the 
patient to its poisonous effects, in the employment of complete 
salivation, upon all occasions, as is common with some practi- 
tioners^ — small doses of calomel and Dover's powder seeming to 



1858.] Campbell's Lecture on Dysentery. 85 

be their panacea for every diseased state, supplying with, this 
convenient compound, the place, often, of diagnosis; and whe- 
ther the patient suffers through the intentional design of his 
physician or his want of judgment as regards the danger of in- 
ducing that state, with this medicine, the injury is the same — it 
is mercurial salivation notwithstanding. 

We would suggest to those who habitually give mercury, as 
a routine or mechanically, because they cannot interpret the 
manifestations of disease, that they might disguise their ignor- 
ance in some less hurtful manner — by giving bread-pills, for 
instance. And for those who wish to purge the patient in Dys- 
entery, we would remind them, that they might employ some 
agent of equal or superior activity, which would not be obnox- 
ious to the same objections, from untoward consequences, owing 
to the peculiar therapeutic properties of this article. Hear what 
Mr. Annesley says upon this subject in his Sketches of the Diseases 
of India — (He performed many experiments with the express ob- 
ject of testing the true operation of calomel) — he says, "These 
experiments presented uniform results, viz., that while the stom- 
ach and duodenum of dogs that had taken large doses of this 
preparation were much paler and less vascular than in ordinary 
circumstances, the colon and rectum, from the caecum to the verge 
of the anus, were most acutely inflamed, thereby explaining the re- 
sults of clinical observation, namely, that although large doses of 
calomel calm those symptoms usually caused by increased vascu- 
lar action, or inflammation of the mucous surface of the stomach 
and duodenum, they lower the vital energy of these important or- 
gans, and occasion tenesmus, griping pains in the course of the colon, 
mucous or bloody stools, hemorrhoids ; and if persisted in, many 
more of the symptoms of Dysentery, or even structural change of the 
colon or rectum. I am confident that Dysentery becomes chronic ; 
that an occasional indigestion lapses into a constant dyspepsia ; 
and that habitual constipation often passes into strictures of the 
rectum, and hemorrhoids into fistulas, from the frequent exhibition 
of large doses of this medicine* Ingenuity cannot devise a more 
successful method of converting a healthy person into a confirm- 
ed invalid, of destroying many of the comforts of existence, and 
of occasioning hypochondriasis and melancholy than the prac- 
tice of prescribing large doses of calomel on every trifling occa- 

* These italics are ours. 



86 Campbeli/s Lecture on Dysentery. [February, 

sion, or when the bowels require gentle assistance; or because 
the patient erroneously supposes himself to be bilious, or is told 
so by those who should know better. The unfortunate word 
'bilious,'' is the scape-goat of the ignorant" 

As to the indispensableness of mercurialization for the cure of 
acute diseases, generally, the dogma has long since been explod- 
ed by the introduction of quinine into general use. And with 
special reference to this disease, it is satisfactorily evidenced that 
no additional benefit accrues to its employment Dr. Bell re- 
marks, that " As regards the use of mercury in Dysentery, it is 
mere empiricism to look to salivation, either as a necessary proof 
that enough of mercury has been administered, or as an indis- 
pensable means of curing the disease. Salivation is an occasional 
result to be deprecated and avoided rather than sought for." 

Now, gentlemen, we would not be understood to wish to de- 
tract from this agent, a whit of its value and importance as a 
remedial means ; but would claim for it, as such, an appropriate 
place, and for its use, a specific object, with due regard to its 
potency and its peculiar properties — and would have you recol- 
lect, that we only caution you against its abuse, the deplorable 
effects of which, there is much recorded testimony to establish. 

Moreover, after all that has been said, should you ask us if 
we give mercury in Dysentery— we would answer, that we do 
give it ; not in all cases, but in many — though, expressly, with- 
out either of the objects which we have been hitherto discussing. 
We use it but as an aid to the treatment — yet not as & purgative, 
for our doses would be insufficient for that purpose : not to sali- 
vate, for it is given under such circumstances as would render 
such a result next to impossible. Formerly ptyalism was attri- 
buted to the patient's taking cold, or drinking cold water after 
taking calomel; and doubtless many a poor victim has been 
goaded on his way and been initiated prematurely into the in- 
conveniences of a warmer climate, by this merciless notion— 
" without one drop of water to cool his parched tongue." For- 
tunately, for the sake of humanity, this error has subsided, and 
it has now become an acknowledged fact, that mercury will not 
affect the system thus, except it be retained from want of ac- 
tion — unless this peculiar property should be determined by 
idiosyncrasy of constitution. We remember the case of a lady, 
of our acquaintance, who cannot take the slightest dose of any 



1858.] Campbell's Lecture on Dysentery. 87 

of the preparations of mercury, although it be followed immedi- 
ately by an active purgative, without suffering all the horrible 
realities of a complete salivation. 

As was premised in our lecture upon the " Pathology of Dys- 
entery," that, either as a co-incident event, or in consequence 
of the pyrexic condition which constitutes a part and parcel of 
this disease — the Liver, in some eases, is found to be in a state 
of disorder or inaction, as is manifested by the yellow, furred 
tongue, tenderness on pressure over the right hypochondriac re- 
gion, and by the persistent stubbornness with which the bowels 
remain in a state of constipation — the retained scybala resisting 
their disintegration and dislodgment. 

Now, it is well understood in Therapeutics, that the different 
elements of the Materia Medica are classified from the fact, that 
they are found to exert their specific agency upon different and 
particular organs. It is also well known, that among the effects 
of mercury, is its peculiar property of u stimulating the torpid 
liver into action ;" and it is as well recognized in Physiology, 
that the product of this secerning organ,- the bile, is the natural 
solvent of the heterogeneous residuum of digestion, the faeces, as 
well as the ordinary excitant of peristaltic action, and thus it has 
been styled "the natural laxative of the system." 

Well, in such cases as are here indicated, and only in such, 
have we found it necessary to resort to the use of this agent. 
And we use it, not as constituting the basis of the treatment, as 
others do, but to counteract an embarrassment in the manage- 
ment of the disease, i. e., the co-incident or consequent derange- 
ment of an important organ, whose suspension in function 
materially interferes with the natural processes, which are ordin- 
arily contributive to relief. With this view, we administer the 
mildest preparation, in small doses, and repeat them as seldom 
as the demands of the hepatic disorder will warrant. And we 
probably anticipate when we say, that in the appropriate treat- 
ment of the intestinal element of this disease, no opportunity is 
allowed for its retention in the system and the consequent effect 
of ptyalism. 

The preparation which we prefer is the following :— 
ty. Blue mass, . . 3j. 

Prepared chalk, 3iij. Triturate well together. 
It forms a blue powder, very similar in physical properties to 



88 CAMPBtfLl/s Lecture on Dysentery. [February, 

the officinal hydragyrum cum creta, to which, we scarcely know 
why, (as they are almost identical in constitution) ; but, be it 
fancy or fact, the former seems much superior and more satisfac- 
tory, in many respects. And this is probably somewhat owing 
to the fact, that this preparation does not have the effect of sick- 
ening the stomach, so common to the officinal article. At any 
rate, the impression has weighed sufficiently with us, to have the 
effect, for many years past, of substituting the one for the other 
preparation, with children, as well as in all other cases, wherein 
its use was formerly indicated. Of this compound, we prescribe 
10 grs. morning and night, or 20 grs. at night, as long as neces- 
sary, irrespective of the other means employed, for the purposes 
of acting upon the liver, and thereby operating upon the faecal 
mass contained in the intestinal canal, to effect its evacuation, 
and we give it with no other design, than thus to assist in the 
accomplishment of the third indication of the treatment that we 
have already distinctly laid down, the requirements of whichy 
being now under our consideration. 

The Saline or purgative treatment, so strenuously advocated 
by MM. Bretonneau and Trousseau, is entitled to our consider- 
ation, as a practice now much in vogue, and which, it cannot be 
denied, is not without favorable evidence in the result of its 
operation in many cases. 

This treatment originally consisted of one or two drachms of 
the sulphate of soda, dissolved in any vehicle and given in di- 
vided doses ; and has been said " usually to arrest Dysentery in 
twelve, twenty -four, or forty-eight hours f and that " any acute, 
Dysentery which is not suppressed in this time by it, demands 
the closer attention of the physician, as presenting complica- 
tions or being of extreme gravity." But this article has been 
replaced pretty generally, in our country, where there has been 
ample opportunity for testing the relative value of all the vari- 
ous practices ever recommended— and where, we must say, all 
the suggestions ever made, have had a full and thorough trial 
with various results— we say that this treatment has been super- 
seded by the substitution of the sulphate of magnesia, used 
pretty much in the same way, as less liable to irritate the sto- 
mach and bowels. A tablespoonful of its saturated aqueous 
solution is given at various intervals to suit the exigencies of 
the case. The acidulated solution is sometimes used, prepared 



1858.J Campbell's Lecture cm Dysentery. 89 

according to the formula, and given as recommended by Dr. 
Henry of Dublin, viz.— " To seven ounces of a saturated aque- 
ous solution of the salt, add an ounce of the diluted sulphuric 
acid of the Pharmacopoeias, and give a tablespoonful of the mix- 
ture for a dose, in a wineglassful of water." 

Now, the action of these salts is similar, and their modus 
operandi and effect in Dysentery, precisely the same. That is, 
they deplete by producing watery stools, or by exciting from the 
mucous membrane of the small intestines, the exhalation or 
secretion of large quantities of serum, the fluid element of the 
blood — probably, through the agency of a species of irritation 
there determined, as the specific therapeutic property of this 
class of agents. 

It presents itself to our mind in considering the applicability 
of this class of remedies to Dysentery, that they must act without 
any special reference to suitableness, or correspondence of their 
peculiar therapeutic properties, to this particular diseased state, 
as well as the ordinary and characteristic requirements of the 
organ and tissue affected, when used under the operation of this 
disease; and that the good they accomplish, whenever it is man- 
ifest, must be by virtue of their depleting properties, as well as 
that of revulsion or derivation, through the species of irritation 
which is engendered in one portion of the canal, deriving from 
that previously existing in another. They also have the effect, 
during their exhibition, of keeping the canal clear of solid ma- 
terial, thus, as long as their use is continued, placing out of the 
question the danger of irritation thereby, to the sore mucous 
lining of the faecal receptacle, the large intestine, which is the 
seat of the disease. But it is an observation which has probably 
presented itself to every practitioner, that as soon as the use of 
this class of purgatives is suspended, there is a proneness to 
constipation more determined than ever. Now, let us consider 
these effects, in relation to the case in question, and with refer- 
ence to the physiological attributes of the organs involved, with 
their dependencies, as well as with reference to the natural* pro- 
clivities of these organs under this condition of disease, which, 
you recollect, we endeavored to develop to you on a former 
occasion, when considering the Pathology of Dysentery. And 
reasoning upon these premises, it is evident, that those cases 1 
which are relieved — (and there are many, when they are treated 



90 Campbell's Lecture on Dysentery. [February, 

thus, in the inception of the attack)— are relieved by virtue of 
dejiletion, as would blood-letting relieve them, and often does. 
And here let us remark, as we may not recur to this subject, 
that there are cases which not only admit of depletion by hydra- 
gogue cathartics, but demand the use of the lancet — although 
these cases are rare. But when the symptoms are extremely 
violent in the onset of the attack, or where there is enteric he^ 
inorrhage threatening danger ; or when, after the appropriate 
management of the two elements of this disease, the symptoms 
do not relax in violence, in a reasonable time — then may re- 
course be had to blood-letting for their abatement, as under the 
same circumstances in any other one of the phlegmasia. And 
we would prefer depletion from the arm, in these rare cases of 
Dysentery, to depletion to any great extent, from the mucous 
lining of the small intestine— a surface continuous with,- and 
connected to, the diseased membrane by nervous, reflex associ- 
tion, as we have endeavored to show — for the following reasons, 
which we may say are borne out by experience. In the first 
place, after a case has been relieved by the depletion of the sa- 
line treatment and the medicine is discontinued, the bowels 
become constipated, as is usual after the exhibition of these 
purgatives — the contained solid excrement passing over the re- 
cently sore surface, has a tendency to re-establish irritation from 
that point, restore the difficulty and "tear agape the healing 
Wound afresh." And we believe that this is the explanation of 
the frequent relapses occurring in cases treated thus. And 
again, we have the phenomenon referred to,- in the pathology of 
this disease, viz : that it has a tendency to run into diarrhoea, 
in the latter stages — the interpretation of which, you recollect, 
was by attributing it to reflected irritation, producing an excito- 
secretory result. Now, if this treatment — which operates by 
exciting irritation at this point, which point is also liable to re- 
flected irritation — -should be carried too far, or be continued too 
long, it must have the effect of predisposing or determining to 
a metastasis of excitement, or so derange the organization of 
the tissue, that when it does occur, as to render it incapable of 
recuperation, and the patient's strength and vitality must speed- 
ily be exhausted in the diarrhoea which supervenes. We have 
had the unenviable opportunity of witnessing two cases, which 
followed this course ad finem, through the patients' or their at- 



1858.] Campbeli/s Lecture on Dysentery. 91 

tendants' disobeying or mistaking instructions, and continuing 
the purgation too far. And since then, we must say, that as for 
ourselves, we have abandoned in toto the saline treatment of 
Dysentery, without the entertainment of a single regret for its 
banishment, for another — one by which the patients or their 
attendants can effect no serious injury by mistakes or disobedi- 
ence of injunctions — and more especially without regret, as we 
have felt that its loss was more than recompensed in the adoption 
and amendment of a treatment of general applicability, and one 
more rationally satisfactory to our mind, inasmuch as it supplies 
fully, what we conceive to be, every demand for the relief of 
that condition of the organism, which we have endeavored to 
interpret to you — a remedy having none of its disadvantages, 
but more than its every advantage. 

Although we have thus spoken of the Saline treatment, and 
of its rejection by us, for a better plan — yet in justice to the re- 
sult of its action in many cases, and to the somewhat appropri- 
ateness of the rationale of its operation — in which, after all, 
there is more of the semblance of reason, than in the application 
of the various other practices, to which we have heretofore re- 
ferred — we deem it but fair, before quitting the subject, to assign 
to this mode its proper place, in strict accordance with the con- 
sideration it deserves. * 

Then, we would say — that it is next in importance, and next 
in reason to that treatment, which it now remains for us to in- 
vestigate, as supplying fully the requirements of the two indica- 
tions under consideration : and well deserves to be borne in 
mind, as second to none other than the latter, in the earlier sta- 
ges of the disease, when from any cause its practicability is 
impossible — yet its use should be always in subjection to the 
proper restrictions, that its dangers may not lurk, too long con- 
cealed, in its more deceptive advantages. 

The appropriate Treatment of Dysentery will form the sub- 
ject of another Lecture. 



4* 



92 Eve's Notes on Diseases of the Cervix Uteri. [February, 



ARTICLE VI. 

Notes to a Report on Diseases of the Cervix Uteri. By Joseph A. 
Eve, M. D., Professor of Obstetrics and Diseases of Women 
and Children, in the Medical College of Georgia. 

Note 1st. — Chlorate of Potash, 

In the July number of the American Journal of the Medical 
Sciences, Br. Bedford Brown of Caswell county, N. C, proposes 
chlorate of potash as an efficacious and certain remedy in the 
treatment of inflammation of the cervix and cervical canal. Dr. 
Brown says: 

"The discovery of some simple aud efficient means as a sub- 
stitute for the uncertain astringent injections in common use, 
and the tedious and often unsuccessful caustic and speculum, 
would relieve the physician of an extremely disagreeable duty, 
and the patient of an almost intolerable necessity. 

" In those cases of leucorrhoea attended with ulceration of the 
os uteri or cervical canal, and enlargement of the muciparous 
glands of the vagina, or simple ulceration without leucorrhoea, 
I believe the injections of the cKrorate far more certain and effi- 
cient than the ordinary astringent injections, or the local appli- 
cation of caustic. In these cases I have not thought proper to 
give detailed reports of their symptoms and progress." 

Since reading Dr. B.'s communication, I have several times 
prescribed the chlorate of potash, and intend to give it a fair 
trial ; for if nearly as efficacious as he asserts, it would be a 
valuable addition to our resources in the management of those 
affections. But when Dr. B. speaks of " the tedious and often un- 
successful caustic and speculum ;" he shows that he has not a tho- 
rough practical acquaintance with cauterization, or at least that 
he has not been sufficiently persevering in his employment of it: 
for if there be certainty in medicine, it is seen in the treatment 
of simple inflammation and ulceration of the cervix by caustics, 
when properly and perseveringly used ; and although oftentimes 
tedious, it is less so than any plan hitherto devised. Chlorate 
of potash will probably succeed well in many of the lighter and 
more recent cases of inflammation of the cervix without or with 



1858.] Eve's Notes on Diseases of the Cervix Uteri. 93 

superficial abrasion, and it will I trust prove at least a more 
valuable adjuvant to caustics than other vaginal injections; but 
I would rejoice to find it prove as efficacious as nitrate of silver 
in the more inveterate and serious cases. It would indeed be a 
great benefaction both to patient and practitioner; and Dr. 
Brown should be justly regarded as a friend, not only to the 
ladies, but to his professional brethren. 

My friend, Prof. Campbell, used chlorate of potash with bis- 
muth with perfect success in a case of inflammation of the cervix 
and vagina, in the City Hospital. This patient had an extensive 
vesico- vaginal fistula, before operating for which, it was neces- 
sary to remove the inflammation. Dr. Campbell prescribed vag- 
inal injections of this salt and subnitrate of bismuth, three times 
per day ; at the end of a few weeks, he examined and found the 
inflammation had entirely disappeared. This patient, it is true, 
was favorably circumstanced for the success of any plan of treat- 
ment, but none could possibly have succeeded better. 

Patients generally speak of it as pleasant in its effect ; one 
patient, however, complained of its causing great pain. This 
was an elderly lady who had for some time complained of symp- 
toms of prolapsus, for which astringent vaginal injections were 
prescribed ; as she was not relieved, a digital examination was 
made, which detected moderate prolapsus, but nothing abnor- 
mal in the cervix except that the os was somewhat more patulous 
than usual. A globular pessary was inserted, which caused 
considerable pain and which she succeeded in removing herself: 
after which the chlorate of potash was prescribed and its admin- 
istration followed by much pain, which is only explicable upon 
the supposition that in consequence of the patulousness of the 
os, it passed into the cavity of the body of the uterus. "When 
this patient had used vaginal injections of cold water a few 
days, a specular examination was made ; the cervix externally 
was perfectly healthy, but intense inflammation was observed 
extending from the os deep into the cervical canal. There was 
in this case a very unusual occurrence, a remarkable exemption 
from leucorrhcea, which induced me to suppose there could be 
very little, if any, inflammation, and therefore to defer so long 
the use of the speculum. In cases wherein there is much prolapsus 
with relaxation of the vagina, it is very doubtful whether injec- 
tions of chlorate of potash will succeed as well as alum and 



94 Eve's Notes on Diseases of the Cervix Uteri. [February, 

tannin in promoting the restoration of the uterus to its normal 
position. 

Note 2nd. — Dr. Tyler Smith and Dr. Eigby. 

In the first part of this Keport the testimony of these gentle- 
men was said to be strongly in favor of the frequency of ulcera- 
tion of the cervix : a little explanation may be proper. Dr. 
Tyler Smith certainly recognizes the frequent' occurrence of 
ulceration, especially of the lighter grades — " epithelial abrasion 
and superficial ulceration "■ — but he considers it to depend on 
leucorrhoea and not to be a consequence of inflammation. He 
observes (page 92) : " The loss of portions of epithelium, the first 
step towards ulceration, is so common in cases of confirmed leu- 
corrhoea, that there must be some very frequent and simple cause 
which produces it, and it appears to me that it is far more rea- 
sonably accounted for by looking to the irritant discharges than 
in any other way." But for full confirmation, we would refer 
to . the whole of the fifth chapter in his able treatise on leucor- 
rhoea. 

Dr. Eigby, employing the term in its most restricted sense, 
excluding all except deep ulcers, does say, (page 105,) "Ulcera- 
tion of the os and cervix uteri, not connected with malignant 
disease of the uterus, is, in fact, a rare affection." But from the 
following paragraphs (page 94), and other passages in his work 
on Diseases of Women, he plainly admits the frequency of in- 
flammation of the cervix, and what Dr. Bennet and others con- 
sider, and very properly, lighter degrees of ulceration. 

" The female generative organs, situated at the lower part of 
the trunk, supporting the chief weight and pressure of the intes- 
tines, and subject to such great periodic alterations of vasculari- 
ty, not to mention the wonderful changes they undergo during 
pregnancy and parturition, are rendered peculiarly disposed to 
be affected by any morbid action which may occur, especially in 
the great machinery of the chylopoietic system, and liable to be 
fixed upon in the various blood diseases, on which to localize 
their energy and expend their virulence. 

" It will therefore be seen that there are few affections of the 
general health in a female, in which the generative system is not 
more or less involved ; and although these local affections, which 
in the first instance are mostly effects of deranged health, react 



1858.] Eve's Xotes on Diseases of the Cervix Uteri. 95 

and produce in their turn considerable sympathetic derange- 
ment, yet it must be borne in mind that, unless a distinct local 
cause be present, they must be looked upon as "the local 
manifestations of a general derangement, in order that we may 
form correct and rational ideas respecting their nature and treat- 
ment. 

"Inflammation of the os and cervix uteri seldom occurs as an 
acute affection, but, in far the majority of cases, in a subacute or 
chronic form." 

It is true, he regards them as most frequently secondary or 
sympathetic affections, depending on the state of the general 
system, disappearing and reappearing as the patient's health im- 
proves or declines, for he says, (page 103) : 

" Allowing for the difference of position, &c, I would say that 
the os uteri presents as great a variety and frequent change of 
appearance as the tongue and throat do ; and I, moreover, feel 
convinced, that if these parts could be as readily inspected, ex- 
perience would soon enable us to recognize the appearances 
which they present as indications of the state of the patient's 
health — much as we are accustomed to do in examining those 
presented by the tongue." 

How this may be when these affectious are recent and slight, 
I do not know ; nor can I conceive how Dr. Rigby has arrived 
at this conclusion ; for when sufficiently intense to indicate and 
justify a specular examination, they have been found remarka- 
bly persistent, varying very little, until they have been properly 
treated ; after which I have never known a case relapse. My 
experience cannot recall a single instance in which a patient, 
after having been cured, has had a return of the disease ; although 
suffering once does not afford any immunity for the future. 

Dr. Bennet says, (page 277,) "Since I have made it a rule 
minutely to investigate the state of the cavity of the cervix, and 
never to dismiss a patient so long as there is the slightest vestige 
of disease remaining, I am much longer in curing my patients, 
but when they are once cured, I never have any relapse of the 
ulcerative disease. The relapses which I formerly used continu- 
ally to witness in the practice of the French surgeons, were 
clearly owing to the disease not being followed into the interior 
of the cervical canal, and thus not being entirely eradicated." 

From the very first, in employing caustic, I have adopted this 



96 Eve's Notes on Diseases of (lie Cervix Uteri. [February, 

rule with respect to the cervical canal, and therefore I do not 
remember ever to have had a relapse. 

Dr. Kigby says, " Inflammation of the os and cervix seldom 
occurs as an acute affection, but in far the majority of cases, in 
a subacute or chronic form." Is it usual for chronic affections to 
present great variety and frequent change of appearance ? 

Note 3rd. — Repetition of Caustics. 

It is very important not to repeat caustic applications too 
often — once weekly is often enough : every sixth day is the short- 
est interval admissible. The eschar does not always fall off in 
a week. After several applications have been made, from four 
to six, it is advisable to allow a period of two or three weeks to 
intervene, that the effect of the caustic passing entirely off, the 
real amount of improvement may appear. If the cauterizations 
be kept up without intermission, it would be impossible to de- 
termine when the patient was cured. A physician expressed 
his surprise, that although he had cauterized the cervix every 
other day for a considerable time, he had not succeeded in curing 
his patient — he was advised to stop and give her an opportunity 
to get well. In another, cauterization was repeated weekly for 
a year : if curable, she ought to have been cured in less time, 
and with fewer applications. 

Cauterizatian ought not to be too often repeated, or too long 
continued. Few cases require more than from five to ten ap- 
plications. I have known four to suffice, and two, even one, to do 
much good ; though sometimes from fifteen to twenty have been 
required. 

Note 4th. — " Dishonest Use of Caustics." 
Among the causes of inflammation of the cervix, Dr. Rigby 
mentions what he terms the " dishonest use of caustics," a favor- 
ite phrase which he uses several times, and which savours more 
of sensoriousness than of sense. That the injudicious use of caus- 
tics may keep up inflammation, or may cause it, when through 
error unnecessarily applied, is highly probable — all are liable to 
make mistakes, especially the young and inexperienced; but I 
cannot comprehend what he means by "dishonest:" certainly 
an unscrupulous money -loving physician can charge what he 
pleases for his advice and visits, without resorting to means so 



1858.] Eve's Notes on Diseases of the Cervix Uteri. 97 

unpleasant to practitioner as well as patient ; most assuredly 
physicians of the great metropolis, Dr. Rigby's confreres, must 
have much less repugnance to making such examinations and 
manipulations, unnecessarily, than physicians in this latitude, 
who are much more apt to neglect them when proper. 

According to my experience, patients are much more profita- 
ble, when treated without caustics ; for if relieved at all, they are 
constantly relapsing and requiring professional assistance. But 
it is to be hoped no one would, for an instant, be so uncharitable 
as to suppose that those gentlemen, who adopt such practice, are 
actuated by a love of lucre. However erroneous their views, it 
is presumed they do what they conscientiously believe best for 
their patients. 

Xote 5th. — Effects of Nitrate of Silver in overcoming 

Sterility. 
Dr. Tyler Smith says, in reference to his 35th case, (page 164.) 
"In this case, as in several others, I attributed the result of 
pregnancy to the application of the nitrate of silver. On both 
occasions the patient became pregnant after a free use of this ap- 
plication immediately before the catamenial period. It appears 
as though the application of the solid nitrate of silver is either 
followed in a few days by a healthy secretion from the surface 
to which it is applied, or the irritating discharges are neutralized 
by its use. Of its influence in removing sterility in leucorrhcea 
I have had many examples. Some cases of this kind which I 
have seen in consultation with Mr. Guthrie, and Mr. "Walter 
Bryant in particular, leave no doubt upon my mind of the effects 
of this remedy, in cases where the disordered condition of the 
secretions of the os and cervix is the cause of sterility." This 
accords with my own observation, for in a review of cases treat- 
ed by nitrate of silver, as very frequent consequences, are ob- 
served conception in patients previously sterile, and fortunate 
gestation in those previously subject to repeated abortions. Its 
influence in removing sterility probably depends on its curing 
the leucorrhcea, which usually attends and which in many in- 
stances is doubtless the principal obstacle to conception. It pre- 
vents abortion, by removing the inflammation and restoring the 
natural condition and healthy action of the cervix in which 
resides the retentive power of the uterus in gestation. 



98 Eve's Notes on Diseases of the Cervix Uteri. [February, 

Many cases might be adduced in illustration : very few may 
suffice. 

Mrs. ■ , from Carolina, had been married 3 or 4 years, and 

was in wretched health as long. She had been under the care of a 
number of eminent physicians and had undergone a variety of 
treatment for various diseases, but as the true pathology of the case 
was overlooked no relief was experienced. This lady suffered 
so many severe local and constitutional symptoms that life had 
almost become a burden, and she had very little hope of ever 
being restored to health. Upon careful investigation, she was 
found to have prolapsus, with inflammation of the cervix and 
cervical canal, to which I thought all her sufferings were fairly 
referrible, that this was probably the primary affection and the 
others secondary and sympathetic. The local affection was 
treated by cauterization with nitrate of silver and astringent 
vaginal injections. The principal constitutional remedies em- 
ployed were preparations of iodine and iron and other tonics. 
Very many intercurrent symptoms and sympathetic affections 
were met by such medicines, as were severally indicated for 
them ; these were indeed so numerous that it would be tiresome 
to attempt to particularize. The treatment of this case, local and 
general, extended over more than two years. The first cauter- 
ization was on the3rd of March, 1853, and the last on the 24th 
November of the same year — sixteen in all, through a space of 
nine months; few cases have ever required as many; but after 
all traces of uterine inflammation had disappeared, she was 
under prescription for the secondary affections during the whole 
of the following year. 

It often happens, when cases have been of long standing, that 
the secondary affections do not subside for a long time, and not 
unfrequently demand considerable treatment. 

Fewer cauterizations, perhaps, might have sufficed, if they 
could have been made with more regularity, but as this lady 
lived at a distance, they were frequently unavoidably deferred 
too long. 

After all traces of inflammation had been removed and leu- 
corrhcea had entirely ceased, this patient was subject to menor- 
rhagia at nearly every menstrual period until June, 1855, when 
she became pregnant, and in the following April gave birth to a 
fine little daughter, since which Mrs. has generally enjoyed 



1858.] Eve's Notes on Diseases of the Cervix Uteri. 99 

very good health. And thus a most amiable and excellent 
couple were rendered as happy as they well could be, who before 
were perhaps equally miserable — the husband from sympathy 
with his wife in her sufferings, and she, perhaps, less from her 
own sufferings than from the distress they caused him. Last 
October this lady was in Augusta, looking as young, and more 
blooming and happy than previous to her marriage, five years 
before. 

This case exemplifies the happy effects of the most patient 
perseverance under the most adverse and discouraging circum-- 
stances. It required a longer course of treatment than any I 
have ever attended, Had this lady not possessed and exercised 
the most indomitable patience, she would have given up in utter 
hopelessness,- long before a cure was accomplished. 

Some two years past, a Scotch lady about 30 years of age* 
some years married, consulted me occasionally for leucorrhoea^ 
for which I prescribed medical treatment and vaginal injections.- 
In 1855 she had an alarming hemorrhage from the womb, which 
might probably have depended upon an early abortion, but no 
embryo or ovum was discovered. She had another excessive 
hemorrhage Nov. 12th, 1856— no embryo or ovum being seem 
Vaginal examination detected very considerable enlargement 
and congestion of the uterus, but no evidence of pregnancy .- 

She was informed that she probably had inflammation or ul- 
ceration of the neck of her womb, and that as soon as she had 
recovered sufficiently from the effects of the hemorrhage, she 
ought to submit to specular examination, by which alone it 
could with certainty be determined. On the 29th of the same 
month, the speculum revealed a deep pus-secreting ulcer, extend- 
ing from the anterior lip into the cervical canal, which was 
freely cauterized by nitrate of silver* Chalybeate tonics and 
astringent vaginal injections were also prescribed. Caustic Was 
applied again on the 12th and 27th of December and on the 10th 
and 27th of the following February— in all, five times. At the 
last examination, in February j there was great improvement. 
Having called two or three times afterwards, without finding 
her at home, and for a long time not having heard from her, I 
lost sight of the case, supposing that, tired of this treatment, she 
had sought assistance elsewhere. 

But, to my surprise, in August she called to inform me that 
n.s. — vol. xrv. NO. II. 5 



100 Eve's Notes on Diseases of the Cervix Uteri. [February, 

since I saw her last, not only the whites, but "the reds," too, had 
ceased, that she had no discharge at all for some months — re- 
marking, with perfect artlessness, what alarmed her most was a 
large lump in the lower part of her stomach, and that her prin- 
cipal distress was being very sick to her stomach, especially of 
mornings. Her gloomy apprehensions were very easily and 
pleasantly dispelled by assuring her that the tumor was perfect- 
ly natural, and that she was just " as ladies wish to be who love 
their lords," 

This worthy lady and her kind husband were made perfectly 
happy in December by the birth of a little daughter. 

This case is remarkable for such happy results, from so com- 
paratively small an amount of treatment — affording great en- 
couragement to patients whose circumstances may not admit of 
regular systematic treatment. 

A lady, twenty-two years of age, who had been married about 
two years, during which time she had one premature birth, came 
from Muscogee county, and remained in Augusta five weeks, 
She had been suffering since her labor, some nine months before 
with the usual functional symptoms of prolapsus and inflamma 
tion of the cervix, which were verified by digital and instru 
mental examination. Nitrate of silver was applied four times 
first, on the 28th day of January, 1854 — on the 8th and 22nd 
of February, and on the 4th of March ; in a few days after which 
she returned home, with a silver-gilt globular pessary. 

Some six months after her return, I heard from her friends 
that she was enjoying good health, with good prospects ahead, 
which were in due process of time happily realized. 

This patient also used astringent vaginal injections. As she 
was very feeble, thin and pale, chalybeate and other tonics were 
prescribed. She suffered exceedingly from vesical irritation, for 
the relief of which she took a comp. syrup of buchu, uva ursi, &c, 
with very good effect. 

The medical treatment was continued some time after her re- 
turn home. 

This case is remarkable for the promptness of its recovery 
from such a distressing state. 

Many more cases might be adduced, but it would be unneces- 
sary and tiresome ; for to me nothing appears more dull and 
uninteresting than a narration of many cases substantially the 



1858.] Eve's Notes on Diseases of the Cervix Uteri. 101 

same. The general rale has been, that married ladies, during 
the reproductive age, have borne children after having under- 
gone treatment by nitrate of silver for inflammation or ulceration 
of the cervix : there are, however, some exceptions ; many of 
these, we believe, are due to displacements, such as retroflex- 
ion, retroversion, &c, which sometimes persist after recovery, 
and are not easily corrected. 

Note 6th.— The Speculum. 

"Whilst it must be acceded that the speculum, like every other 
valuable medical or surgical means, has been abused by being 
employed in cases to which it is not applicable— in which it 
could neither throw light on the pathology, nor prove of any 
benefit in the treatment. But attemps have been made to throw 
unjust and undeserved obloquy upon its use, by some from 
whom better things might have been expected : As an instance 
in point ; Dr. Eobert Lee makes the following illiberal and ill- 
natured remark: — " The speculum emanates from the syphilitic 
wards of the hospitals at Paris, and it would have been better for 
the women of England, had its use been confined to those insti* 
tutions." 

It is true, that all of the most important discoveries in patholo* 
gy, and valuable improvements in practice, have not resulted 
from experiments and investigations made in the Parisian hos* 
pitals ; but if physicians, from pride or prejudice, were to ignore 
or repudiate all that has emanated from that same source, who 
could calculate the immense loss to science and to humanity ? 

Admitting, for argument, that the speculum emanates from 
the venereal wards of Parisian hospitals— does not Providence 
often bring good out of evil ? And on whom could it be more 
justifiable to make investigations and experiments, that might 
redound to the benefit of the good and virtuous, than on the 
vicious and profligate of the same sex ? 

There is no doubt but that the speculum has often been mis- 
used—that is, applied in cases wherein no knowledge could be 
obtained or benefit secured, as, for example, in some cases of 
large polypi and other tumors, and of cancer, especially when 
far advanced, and in the various displacements and malpositions 
of the uterus. 

But the speculum frequently reveals much important informa~ 



102 Eve's Notes on Diseases of the Cervix Uteri. [February, 

tion, which cannot be obtained by the finger alone. Many- 
morbid changes which are not palpable to the touch are easily 
detected by the eye. 

Dr. Churchill (page 29, Dr. Con die's edition) makes the fol- 
lowing very sensible remarks in reference to the employment of 
the speculum : 

"It enables us to ascertain accurately the length and thickness 
of the cervix uteri, to detect variations from the natural color of 
the mucous membranes, slight erosions which might be passed 
over by the finger, elevations on the cervix uteri or walls of the 
vagina, too little raised to impress the sense of touch ; small 
vesicular polypi within the os uteri, eruptions upon the cervix, 
and we are enabled to discover the color of the surface of an 
ulcer. It will also confirm many characters recognized by the 
touch. On the other hand, we must be careful that we do not 
mistake for morbid changes those appearances which are caused 
by the instrument itself. For instance, pressure en the outer end 
of the instrument may change the elevation and position of the 
uterus, and produce swelling and pufrmess of the cervix. There 
can be no doubt of the great value of the speculum! both for the 
detection of disease, and the application of remedies ; but it is pos- 
sible that injury, beyond the violation of delicacy, may be occa- 
sioned by it. It should never be used, if it be possible to avoid 
it, in virgins ; or when there is any alteration of tissue, involv- 
ing its greater liability to laceration, and as rarely as possible 
with nervous women." 

Dr. Churchill has omitted inflammation and ulceration ex- 
tending into the cervical canal, which are of very frequent occur- 
rence, and, generally at least, are not at all discoverable by the 
finger. 

His caution against mistaking "for morbid changes appear- 
ances caused by the instrument," is very well timed and 
judicious, especially in using Kicord's four-branch speculum, 
which he recommends very highly and which formerly I em- 
ployed much oftener than any other. This speculum pos- 
sesses the advantages of being very easily introduced when 
the blades are closed, and of giving a good view by the sepa- 
ration of the blades in the vagina, but it is perhaps more 
liable than any other, in expanding, to give pain, and by 
irritating the vagina and cervix to cause temporary discolora- 



1858.] Eve's Notes on Diseases of the Cervix Uteri. 103 

tions, which might deceive the unpractised eye and possibly 
mislead the more experienced. Another great objection is that 
if necessary to change its position at all, it must be withdrawn 
and re-introduced, for otherwise the expanded blades could not 
fail to irritate and cause pain : it is also very apt to give pain in 
being withdrawn ; unless closed with great care, the extremities 
of the blades will almost certainly irritate, and if not withdrawn 
gradually and cautiously while closing, the mucous membrane 
of the vagina will be pinched. 

Having tried and rejected a large number of complicated and 
expensive specula, I now decidedly prefer the glass mirror spec- 
ulum, in general at least, to all others. Although it has no 
obturator, by introducing the projecting lip first carefully, and 
pressing it gently backward against the perineum, it may be in- 
troduced almost if not quite as easily as the bivalve or quadri- 
valve with the obturator ; and then it may be moved freely in 
any direction after its introduction so as to bring the os and 
cervix in view, if needs be to hook them up and bring them for- 
ward, when, as often found, inclined too far back to be readily 
seen. 

Much has been said against the speculum on the score of deli- 
cacy ; but I cannot perceive that it is any more indelicate to 
make a specular than a digital examination ; it is the necessity 
of the case that renders either proper, and I do believe a truly 
sensible and delicate lady would submit to the one as readily as 
the other — indeed, were it not that a digital examination almost 
necessarily precedes the introduction of the speculum, the spec- 
ular would involve less indelicacy than the other; for example — 
were it practicable for the speculum to be introduced without 
the intervention of the physician, as I have known, in a few 
instances, by the patient herself, or a female friend, and the 
physician only required to look through it and, if necessary, 
make an application, would it not wound her delicacy less than 
a digital examination ? It is said that it involves more expo- 
sure, but this is not necessary ; for it certainly can, by proper 
care, and ought always to be avoided. 

"When the speculum gives much pain, its use ought to be de- 
ferred, until the patient is better prepared for it, by soothinc 
and sedative vaginal injections. I cannot conceive that any in- 
jury can result from the speculum, when used with proper care 



104 Eve's Notes on Diseases of the Cervix Uteri. [February, 

and caution, and under circumstances to indicate and warrant 
its application. 

Dr. Churchill says, il it should never be used, in virgins, if it 
be possible to avoid it," that is, if at all compatible with the 
proper treatment of their diseases, and the same may be said in 
reference to all ; but besides the greater physical difficulty and 
liability to inflict pain and injury, it is proper, on other consid- 
erations, to defer it longer in the former, and wait until the 
necessity is great indeed. 

But when there is truly a necessity for a specular examination 
in virgins, the physical obstacle is generally not so great as the 
objection we naturally feel to subject them to any such investi- 
gations ; for the long continuance of uterine disease has the effect 
of so relaxing and dilating the vagina, that an examination is 
attended with comparatively little difficulty. A respectable 
young lady had, at 13 years of age, about the time of the first 
eruption of the menses, been thrown from a horse with great vio- 
lence, alighting on her pelvis, ever since which, she had been 
subject to symptoms of prolapsus, "When examined at 17, her 
womb was very much hypertrophied, and at the orifice of the 
vagina which was so relaxed, that almost any speculum could 
be introduced with ease. 

On a distant visit, in 1856, I was requested to see a married 
lady, about 20 years of age, who had a decided procidentia, the 
uterus projecting about two inches beyond the vulva: she and 
her mother told me, she had had this affection five years before 
her marriage, which had taken place a few months before I saw 
her. She was of very respectable family, and of unimpeachable 
character. 

These are indeed extreme cases, but more or less relaxation 
always results from uterine disease of long standing. In any 
case wherein it may be at all proper to make a specular ex- 
amination, Whitehead's bivalve speculum may be used with 
safety. 

As respects the position ; in many cases, it answers very well 
to have the patient on her back, or on her side, with the pelvis 
near the edge of the bed ; but very frequently there is a great 
advantage in having the patient on her knees and elbows, as 
recently advised by Dr. Churchill, and many years ago by Pro- 
fessor Antony. In this position, with the thorax lower than the 



1858.] Eve's Notes on Diseases of the Cervix Uteri. 105 

pelvis, gravity causes the womb to pass from the floor of the 
pelvis toward the abdominal strait, elongating the vagina to its 
full extent, so that, if not shortened by the long existence of 
prolapsus, the os will be about the centre of the pelvis, and there 
will be ample room to inspect the whole sub vaginal portion, and 
to make a satisfactory application to any part of it ; whereas, 
when the patient is on her back or side, situated, as the womb 
often is, low down and in the axis of the superior strait, the 
speculum passing in the direction of the axis of the inferior 
strait, they necessarily meet at such an angle that it is often im- 
possible to obtain a good view of the os, or to insert a piece of 
caustic into the cervical canal. When the uterus has approach- 
ed so near the vulva, as to have necessarily changed its direc- 
tion from the axis of the brim to that of the outlet, it is of 
course most easily inspected while the patient is on her back 
or side. 

The position of the uterus in the pelvis and the condition of 
the vagina, must determine what position of the patient will be 
most eligible in each particular case. 

It is utterly futile to declaim against the speculum in cases de- 
manding its use, when, in Europe and the United States, so many 
hundreds and thousands of the most interesting and valuable of 
the sex, whose health was wrecked, and whose lives were ren- 
dered miserable, with an untimely grave in view, have, by 
treatment involving its use, been restored to health and to happi- 
ness, and have become again blessings to their families and to 
society, without the slightest diminution of purity, or even of 
delicacy, and in the highest possession of every moral and reli- 
gious excellence that can beautify and adorn the female char- 
acter. 

With such witnesses in its favor, the opponents of the specu- 
lum will exhaust their disapproval in vain declamation. 



106 Report upon the Topography and [February, 

Dr. Posey's Eeport. 

[The following very able Eeport was presented to the Ameri' 
can Medical Association by Professor K. D. Arnold, of Savannah, 
at its last meeting, in Nashville, J)r, Posey, the reporter, not 
being able to attend the meeting. Appreciating its deep inter- 
est to the Southern Physician, and especially those of our own 
State, in a statistical point of view, we begin its publication in 
our present number. The balance of the paper, relating to Epi- 
demic Diseases, will find a place in our March number. 

Georgia certainly has no reason to complain — she has record* 
ed herself pretty fully in the last volume of our National Trans* 
actions, 

Report upon the Topography and Epidemic Diseases of the State of 
Georgia. By Jo#N F. Posey, M, P., of Savannah, Ga, 

The State of Georgia must, for purposes of medical topogra* 
phy, be divided into three unequal parts. 

The largest occupying more than half the area of the State, 
extends from the sea-coast and Florida line on the south to the 
head of navigation of the larger rivers. 

The second division is separated from the first by a line be* 
ginning at Augusta, at the head of navigation in the Savannah 
Eiver, and running nearly west-southwest, by Milledgeville and 
J^acon, to Columbus, at the head of navigation in the Chatta* 
hoochee ; and is bounded on the northwest by a line drawn 
from the northeastern corner of the State, and running nearly 
southwest till it reaches the western boundary line of the State, 
about half way between Columbus and Nicajack, on the Ten* 
nessee Eiver. 

The third occupies all the space, within the State, lying north- 
west of the last mentioned line, and is much smaller than the 
second. 

The first division is, geologically, of tertiary formation, vary* 
ing in height and quality of alluvium according to the distance 
from the sea-coast. 

Dr. P. M. Kollock describes the part nearest to the sea thus : 

u The topographical features of this district may be distin* 
guished into three separate orders, marked by strips or sections 
extending lengthwise from northeast to southwest. 

*' Commencing with the Sea Islands on the east, we remark a 
series of sand-knolls or hillocks, apparently washed up by the 
gea from its bottom, varying in elevation, intersected by salt- 
marshes and creeks, and inclosing frequently brackish ponds 
and lagoons. 



1858.] Epidemic Diseases of the State of Georgia. 107 

M The growth of these islands is live-oak, water-oak, bay, gum, 
and pine. The live-oak predominates on the southern parts of 
the islands, almost to the exclusion of the pine ; while this last 
is found at the northern end, 

" The soil is a grayish and yellowish-brown sand, mixed with 
shells and vegetable mould, without any mixture or substra- 
tum of clay. This soil, for the most part, is thin, extending only 
a few inches in depth. 

" These islands are separated from the mainland by extensive 
salt-marshes, which are intersected by numerous creeks, and 
overflowed by every high tide. 

" The islands are also separated from each other by sounds, 
or arms of the sea, which are the outlets of the rivers to the 
ocean. 

"Leaving the islands, and crossing over to the main, we enter 
upon another section or strip of country, varying in its topo* 
graphical features from the islands ; a low pine-barren, intersect- 
ed with the rivers and swamps before mentioned. 

"The growth of these barrens is the short-leaved pine, mim 
gled with scrub-oaks and gums. The soil is sandy, with here 
and there a sprinkling of red clay. 

" In wet seasons, while the swamps are full of water, this 

Eine-barren soil is kept in a sobbed state, the drainage being bad 
y reason of its flatness. 

"Passing across this section, inland, twenty or thirty miles 
in width, we strike a somewhat more elevated and rolling region 
of sand-ridges and hills, intersected with bay -galls and branches, 
and sometimes ponds, 

" The soil is sandy, with a substratum of clay at varying 
depths. The long- leaved pine takes the place of the short, and 
predominates, to the exclusion of almost every other tree." 

The mainland adjoining the salt-marshes, which divide it 
from the Sea Islands between the Savannah and Altamaha 
Rivers, usually commences with a line of bluffs, which rises 
twenty or thirty feet above the level of high water, separated 
by arms of salt-marsh and small streams of fresh water, carrying 
the water springing from a line of sand-hills twenty or thirty 
miles further inland. 

These streams have a tide flowing a distance of ten or fifteen 
miles above the bluflfe, and for about the same distance further 
they are margined by a fresh- water marsh and swamp, from half 
a mile to a mile in width, with strips of higher land between 
them, which are of an older formation than the alluvium of the 
swamps, this last being yet in the process of deposit. 

Some of these strips of higher ground are remarkable for the 
growth of plants not usually found growing so near the sea- 
coast. 



108 Report upon the Topography and [February, 

Between the line of bluffs and the line of sand-hills the great- 
est part of the rice which is grown in Georgia is produced, and 
also much of the long-stapled cotton. 

The line of sand-hills is an abrupt rise from a comparatively 
level plain, of about sixty feet, which height is very gradually 
increased as the distance from the beginning line is increased, 
with a succession of undulations of no great altitude, except 
near the river swamps. These swamps are like wide, shallow 
valleys cutting through the undulations, in which the streams 
meander from one side to the other, without any apparent cause 
for keeping any particular course. 

These valleys are filled to their present surface-level with the 
most recent alluvium, the vegetable mould now forming on the 
spot, sometimes covered with water and a growth of cypress, and 
in other places dry, with a heavy growth of such trees and bush- 
es as delight in a damp, rich soil. 

Into these swamps and lowlands the above-mentioned undu- 
lations project more or less, producing an irregular line of river 
hills, having the valleys between them gradually rising from the 
level of the river swamps to that of the innumerable ponds that 
are scattered all over the face of this part of the country. These 
valleys, which carry off the surface water after rains, wind 
about among hills of but little height above them, until ap- 
proaching the river swamps, where they seem to have been 
washed deeper, but are accompanied in their whole course by 
that kind of water-drain called by the inhabitants " bay-galls," 
which are from thirty to sixty yards or more in width ; these 
are like the river swamps, on a smaller scale, and often resem- 
ble vast hedges dividing fields of open pine-barren, or dense 
thickets of low whortleberry-bushes, or species of Andromeda 
called by the people " tie-tie." 

When these bay-galls, in their course to the river, meet to- 
gether, they make considerable streams, which seldom run dry, 
and in some places have cut for themselves channels with fall 
sufficient to drain the swamps on their sides for some distance ; 
these channels are commonly filled more or less thickly with 
silicious stones, often being casts of some bivalve. 

What is here called "rotten limestone," probably underlies 
this whole region, and is found in digging wells, where they 
have to be sunk deeply ; and where this is the case, the water 
is commonly impregnated with what seems to be putrid animal 
matter, which renders it exceedingly disagreeable, and, in the 
general opinion, unhealthy. 

At the distance of about one hundred and twenty miles from 
the sea, the rotten limestone ceases, and mica-schist begins to be 
found in the beds of rivers and other deep excavations ; here, 
also, the hills are higher and steeper, and oak and hickory 



1858.] Epidemic Diseases of the State of Georgia. 109 

are mixed with the pines ; cypresses are no longer found, and 
the small water-courses have high, steep banks, without swamps; 
here, also, the long-leaved pines cease, and soon the primitive 
formation crops out. 

South of the Altamaha Kiver, after leaving the tide- way, the 
face of the country is described by Dr. Kollock thus: — 

u The soil varies in its equalities and appearance, " being 
either a dark-gray or a black mould, and is superficial, with an 
argillaceous substratum to the depth of five or six feet, and in a 
dry time becomes so hard that it is almost impervious to the 
plough or hoe, and cracks in every direction, forming exten- 
sive fissures of considerable depth." In such localities it is rare 
to find good water. According to Dr. T. S. Hopkins, of Wayne 
County, white clothing, washed in this water for a time, will 
assume a yellowish hue, analogous to that which would be pro- 
duced by a very weak solution of sulphate of iron. 

" This section of country, says the same gentleman, is known 
as the " lowlands," and is invariably abandoned by the plan- 
ters in the early part of June. 

"In a very dry or very wet season, the negroes on the plan- 
tations seem to enjoy almost an entire immunity from the severe 
grades of bilious remittent and congestive fevers which are 
common at other seasons, 

" Immediately above the lowlands, in Glynn County and the 
great Buffalo Swamp, the land rises at least eighteen feet, the 
soil is sandy and poor, the growth chiefly pine and blackjack, 
intersected occasionally by spring branches, which afford at 
almost all seasons of the year an abundant supply of fine water. 
The well-water throughout this section cannot be surpassed in 
purity and coolness even by our mountain springs." 

On the south, in Ware County, is the great Okefonokee 
Swamp, of which it is not necessary to say more than that it is 
but little known as yet ; but a survey, by order of the legislature 
of the State, is now in progress. 

On the west, and further inland, "the face of the country," 
says Dr. H. Briggs, of Troupville, " is level, rolling somewhat 
in the southern half, interspersed throughout with shallow ponds 
and bays, some of which are timbered, others destitute of trees ; 
filled to overflowing with water during the rainy seasons of 
winter and spring, but usually nearly or quite dry during the 
latter part of summer and autumn. 

"There are some ponds of a different kind in the southern 
part. They appear to have been formed by portions of land 
settling down, and the water rising to a considerable height 
above the depressed portions. 

" These were formed a long time since, as the banks are now 
very evenly sloped, and covered with trees of mature growth. 



110 Report upon the Topography and [February, 

They are usually round or elliptical, varying in depth from 
three to fifteen or twenty feet, not very sensibly affected by rain 
or drought. 

" There are in almost all sections some evidences of lime un- 
derneath the clay, such as lime-sinks and sundry subterranean 
passages, into which the creeks pour a part of their waters ; also 
some lime-water springs. 

a The country lies upon the Mexican Gulf slope, the declivity 
being from fifteen to eighteen inches to the mile. The water- 
courses have a general southern course, and are all tributaries 
of the Suwanne or Ocklockonnee Eivers. The creeks and bran- 
ches spread far and wide after a rainy season ; and after a long 
dry summer they are either dry, or nearly destitute of running 
water. The largest are mere drains for the surface water. 

" The soil is a sandy loam, underlaid with clay at various 
depths, from six inches to several feet. 

" The well water is soft and generally free from lime, except 
after protracted drought. 

" The country is generally covered with pine forests, and the 
wild grasses and flowering plants indigenous to all this region. 

"There are some isolated portions of country covered with a 
heavy growth of oak, hickory, magnolia, &c. The bays and 
margins of the creeks and branches are wooded with cypress, 
bay, gum, water-oak, live-oak, and a dense undergrowth of 
evergreen shrubs. 

" The pine lands are moderately productive, yielding corn, 
cotton, potatoes, rice, sugar-cane, wheat and oats. 

" The hammock lands are more productive, but probably not 
more durable. Very little has been done, as yet, in the way of 
reclaiming bay or swamp lands. 

" Oyster and other marine shells abound in the beds of all the 
larger streams ; they have undergone silicious petrifaction. 

" In the southern part, along the banks of the streams, speci- 
mens of chalcedony, large masses of yellow limestone, and orbi- 
tulite are frequent. 

" About midway between the Atlantic and Gulf coasts, the 
temperature in summer, during the day, is often as high as 
ninety or an hundred degrees ; I have not known it to exceed 
one hundred and two degrees at any time. The nights are sel- 
dom oppressively warm after nine P. M. The gales that so fre- 
quently prove disastrous upon the Atlantic coast, are scarcely 
observed here, Those of the Gulf coast are sometimes severely 
felt, particularly in the western part of the district," 

The second division of the State begins on a line running 
from Augusta by Milledgeville and Macon, to Columbus, being 
the head of navigation in the principal rivers of the State, and 
differs entirely from the first in geological formation, being 



1858.] Epidemic Diseases of the State of Georgia.- Ill 

primitive ; and the face of the country, which is more hilly, and 
the streams being mostly confined between high banks, and 
without any marginal swamps, with rocky beds, over which the 
current is generaDy very rapid. 

The hills, near the larger water-courses,- are commonly very 
steep, often with large masses of coarse-grained granite piled up 
like houses, and rapidly disintegrating, from the effects of the 
weather. These hills are composed of clay of various colors, red 
predominating on the higher parts, while in the deep cuts made 
by the streams, a white, extremly tough plastic clay is found, 
mixed with a very fine white sand, with white flint stones, often 
in oblique cubes, with unpolished surfaces. 

In some places dikes of silex, or of coarse mica, cut into the 
hills like veins of a mine, as if immense masses of granite had 
been decomposed into clay, leaving veins of silex or mica in 
place. 

The red clay always contains grains of silex, and sometimes 
mica in very considerable quantities. Transparent crystals of 
qnartz abound, sometimes single, but mostly covering a mass of 
agate, or lining a cavity in the same. Small masses of felspar 
are found on the surface, and geodes, an ineh or less in diame- 
ter, containing a quantity of red ochre. 

There are places in the central parts of this division, where the 
granite lies bare, like an old field of some acres, having banks 
around it like those of a tranquil water-course, green with moss- 
es and constantly damp. 

The soil is a light gray, and strong, and very productive 
while new, but very quickly destroyed by careless cultivation, 
such as has been practiced ever since the first settlement of the 
country, leaving bare the clay, upon which scarcely any vege- 
table can grow. 

The most productive lands, and those which are longest in 
being exhausted by the slovenly cultivation aforesaid, are those 
called here " river low grounds," where the surface to a varying 
depth, sometimes more than ten feet, is composed of vegetable 
matter intimately mixed with the washings from the hills. This 
land is always highest immediately at the edge of the stream, 
and gradually becomes lower, until it reaches the foot of the 
hills, where there is often standing water. 

A large portion of the cultivated land in this part of the State r 
is in what is called "the Flat-woods," being table land on a 
small scale, at a distance from the largest streams, having a stiff 
clayey soil, not very pervious to water, and therefore, in a wet 
season liable to be soaked, and sometimes overflowed, the water- 
shed not always being very obvious. 

The forest growth is oaks of several species, hickory, chestnut, 
black walnut, pine, beach, maple, dogwood, buttonwood, here 



112 Report upon the Topography and [February, 

called sycamore, crab-apple, &c., in the order of frequency here 
indicated. 

The northern part of this division contains most of the rich 
mines of gold, copper, &c, with mineral springs in various 
places; but the springs and wells in general furnish very pure 
' 'freestone" water. 

The temperature varies much in the different parts of this 
division ; along the southern boundary line the summer days, 
in dry weather, are oppresively hot, with little wind, while the 
nights are cool and pleasant Thunder squalls are frequent, 
stirring up the atmosphere, bringing down the cold air from 
above, while the rain washes the dust from the vegetation, re- 
freshing everything. 

In the winter the thermometer, seldom below zero, is very 
variable ; light snows are common, sometimes lying in the 
woods two or three weeks. 

Approaching the mountain region, the summer heat is miti- 
gated and the cold of winter is increased, and the temperature 
is more governed by the course of the winds, snow lying on the 
mountains till late in the spring. 

The third division comprehends the limestone region of Upper 
Georgia. 

For information from this region, I am indebted to Dr. Kobert 
C. Word, formerly of Cassville, now of Borne. "There is no 
material difference," says Dr. Word, " in the geological features 
of the several counties. There is in each the same succession 
of broad valleys of rich fertile land, separated by intervening 
ridges, from one to several miles across, of various degrees of 
elevation, rising, in some instances, to the magnitude of moun- 
tains, originally covered by a dense forest, now rapidly disap- 
pearing. These valleys are well watered by streams fed by 
large springs, which gush up from beneath the substratum of 
limestone underlying the surface at various debths, through- 
out their whole extent. 

" The rains of winter and spring fill the stratum of earth 
above the limestone with moisture, and give rise to innumera- 
ble temporary fountains (called wet weather springs) at the base 
and on the sides of the hills, and all over the valleys. These 
all flow into the permanent streams, and occasion a great dis- 
proportion in the height of their waters between wet and dry 
seasons. 

" The stratum of limestone, and in many places one of alumina 
above it, presents a great obstacle to the absorption or ready 
penetration of the superabundant water deeply into the earth, 
and consequently there is excessive humidity of the surface, and 
in many places large pools of water, or shallow lakes of consid- 
erable extent, during the months of January, February, and 



1858.] Epidemic Diseases of the State of Georgia. 113 

March. The three succeeding months are generally delightful 
in temperature. The genial warmth of the vernal sun quickly 
evaporates the excess of moisture — the dreariness of winter is 
dispelled, and its fathomless abyss of cohesive mud forgotten in 
the contemplation of the gorgeous scene displayed with magical 
celerity by the luxuriant vegetation. 

" The summers are by no means so depressing as upon the 
seaboard, or in the middle portion of the State. The thermom* 
eter occasionally, in the hottest part of the day, rises as high as 
90° or 92° of Fahrenheit, but the nights are cool and refreshing, 

"The same geological formation which favors the accumula- 
tion of water near the surface of the earth in winter explains 
also the remarkable absence of it during the months of August, 
September, and October, when in dry seasons, the ground is 
parched and cracked in many places, the atmosphere filled with 
dust, vegetation languishing, and where the stratum of earth is 
thin, totally destroyed ; the temporary springs, branches, and 
lakes all dried up, many of the wells exhausted, and the water 
in the permanent streams, reduced to its minimum, creeps slug- 
gishly through the accumulated piles of drift-wood, which par- 
tially block up the channels through which it flows. 

" The highest heat of summer is of short duration, and the 
temperature of the entire autumn is delightful, 

" The two principal streams in this section of Georgia are the 
Oostenaula and the Etowah, which, meeting at Eome, in Floyd 
County, form the Coosa, a stream navigable for steamboats 
many miles into the State of Alabama. 

" These rivers drain nearly the whole of the fifth congression- 
al district, and are of great size, but not different in their cir- 
cumstances from their smaller tributaries, though much of the 
alluvial land upon their banks, subject to inundation, is still 
covered with primeval forest 

"Throughout all the limestone region numerous sinks and 
depressions are observable on the earth's surface. Many con- 
tain water during the winter, but become dry on the approach 
of warm weather. Others are permanently filled with clear pure 
water. Subterranean caves are also numerous, especially in 
the counties of Cass, Waker, and Dade. 

"The great alternations of moisture and temperature, so com- 
mon to our winters, are probably due to the character of the 
prevailing winds, which are exceedingly variable, not unfre- 
quently shifting their position to all the points of the compass- 
in a period of less than twenty-four hours, each change in direc- 
tion being attended with a corresponding change of tempera- 
ture. The southeast winds, blowing from the Atlantic coast 
during the greater part of fall and winter, are attended with 
frequent rains, cold and penetrating in their effects upon the' 



114 On Rheumatism. [February, 

system. East winds are attended with cold drifting rains, and 
frequently with sleet ; south winds with copious showers, not 
quite so cold ; southwest winds with frequent showers, rather 
warm. As the wind approaches the west, the rain ceases, 
though the clouds continue until it reaches a point north of west, 
when the weather becomes fair and cool. Due north winds are 
very cold, though not usually of long continuance. Northeast 
winds are not common,- and when they do occur, are apt to 
bring with them snow. In the spring, we have rains and pas- 
sing showers from the west and southwest. In summer we have 
showers mostly from the west and northwest. 

11 Situated and forming the dividing line between the grains 
growing sections of Tennessee and the cotton region of Georgia, 
the limestone counties of Cherokee Georgia, are not wholly un- 
suited to the production of either. Though best adapted to the 
growth of grain, grasses, and stock, the more southern counties 
have been found to produce abundant crops of cotton. The 
soil on the creek and river bottoms is rich with alluvial deposit. 
In many places, both in the valleys and more elevated country, 
the soil is strongly impregnated with iron, constituting the "red" 
or " chocolate" land, exceedingly fertile, but u thirsty." 

[To be concluded in March No.] 



On Rheumatism of the Epithelial and Non- Epithelial Fibrous Tis- 
sues : Its Sequence to Scarlatina and other Exanthemata. On 
Rheumatic Gout, Chorea, &c. &c. By H. P. DeWees, M. D. 
New York. 

(Concluded from January No. p. 63.) 

The secondary abscesses following rheumatism, result in most 
cases, from local phlebitis, or from the detention of minute fibrin- 
ous plugs arresting the circulation in the small vessels. Some- 
times, the breaking down of larger plugs with interior pus, causes 
irritation to be established, with more or less serous infiltration 
into the adjacent cellular tissue, the abscess varying according to 
the local arrest. The limits of this paper, however, will not allow 
more than mention of these conditions. I will merely refer to 1 
the pathological facts of the vessels becoming inflamed, and sub- 
sequently thickened or plugged up, so that more or less perfect 
closure ensues, with resolution into abscess, or into mortification, 
either local, or at a distal point, if the large vessels are arrested in 
their circulation. The nature of the gangrene, whether moist or 
dry, will in great measure depend on the perfection of the closure. 
Sometimes, however, the surrounding parts become so agglutina- 
ted by the adhesive action of repair, as to render the neighboring 
tissues anatomically unrecognizable, and totally unfit for their pur- 
poses of secretion or of motion. If such deposit take place in the 



1858.] On Rheumatism. 115 

lungs, the damage is the same, and in this way vomicae may arise 
perfectly independent of tubercular origin, a plug of fibrin not 
as large as the head of a pin arresting the local circulation, with 
consecutive destructive changes; so that rheumatism, by its re- 
sults, may become the parent of evils, equal, in their destructive 
tendencies over life, to tubercle in its highest state of develop- 
ment and disintegration. If the vessels of the brain become the 
seat of arrest, its nutrition will be more or less interfered with, 
and local atrophy or softening may ensue, with lesions of motion, 
or of intelligence, as resultants. And thus paralysis and imbecil- 
ity may follow in the train of that so-called " simple rheumatism/' 
* The cases of paralysis after rheumatism of the spinal invest- 
ments are not unfrequent. On dissection, this apparently high 
inflammatory action, so complete in its functional arrest as even 
to eventuate in death, cannot at times be recognized by the eye, 
as regards structural change. And the same can be said of it 
when seated in the serous membranes of the brain; the so-called 
inflammation being a specific poisoning of the very centres of life, 
leaving neither trace nor residue, 

In the gouty the blood poison is not always exhibited by the 
' ; big toe" attack, with increasing demand for flannel. The skin 
may become the beacon of its approach. Lichenous, herpetic, 
or other eruptions, painful to bear and obstinate to treat, may not 
only mask the attack, but for a long time keep it in " masterly 
inactivity." And the same, at times, may be said of the poison 
of rheumatism. 

It would appear, from reasoning on the facts adduced in the 
study of rheumatism and gout, that if the lactic acid formations 
are in excess, either by over-generation or by non-elimination, 
that an attack of acute rheumatism is apt to follow, and especially 
after the sudden drying up of these eruptions. If this does not 
take place, but the skin disorder recedes slowly, and there is ap- 
parently but a small excess of lactic acid retained, the rheumatic 
pains are irregular, flying from spot to spot, or the joints become 
more or less stiff, not from any difficulty in their opposing surfa- 
ces, but from muscular inability to apply the necessary force to- 
wards movement. If, on the other hand, the uric acid is not ex- 
pelled, or is generated in excess, gout is the frequent successor. 
At this moment I have two cases that would apparently verify 
these views. 

The white fibrous tissue is the chief texture affected in simple 
acute or true fibrous rheumatism, either as it occurs in the for- 
mation of the ligaments connected with joints, or in the mem- 
branous form covering tendons, or in the aponeurotic expansions 
of the large muscles, as the fascia lata of the thigh, with its deep 
prolongations, or in the cranial dura mater, sclerotica, &c. 

It will be necessary to bear in mind that the sheathes of ten- 



116 On Rheumatism. [February, 

d 0Ils — the bursae (sometimes called the bursal synovial mem- 
branes) between the tendons of muscles, between tendons and 
bones, and between the projecting parts of bones and skin, as the 
olecranon, &c, have no epithelium, — although in function they 
resemble the true synovial membranes, yet they differ from them 
anatomically and in exact analysis. But this is not the case in 
the bursa? communicating with the synovial capsules ; these as well 
as the articular cartilages, have an epithelial layer. These ana- 
tomical peculiarities are to be remembered, as they form the dis- 
tinctive features in the pathology, diagnosis, and treatment. 

Although the synovial membranes are not so prone to the effu- 
sion of plastic lymph, as are the serous, yet the bursae are at times 
found not only traversed by adhesive bands, but even completely 
obliterated. The movements in such conditions are greatly im- 
peded, but not so completely, as when the sheaths of the tendons 
are in a like manner affected, the free play of the attached mus- 
cles being rendered more or less impossible. 

The fact is not to be lost sight of, that a large proportion of the 
urea is derived from the disintegration of the body tissues, espe- 
cially of the gelatinous and albuminous orders, independently of 
the introduction of nitrogenized food into the system. It is chiefly 
or at least frequently, in rheumatic disorders which are the off- 
spring of deranged secondary assimilation, that urea forms so fatal 
an agency, although nervous depressions and coma arise in non- 
rheumatic diseases ; as those of the kidney, or from puerperal 
causes, &c. Indeed, in many diseases involving the serous mem- 
branes with kidney difficulty, urea forms a dread element, whilst, 
by its non-elimination, or selective error, it lies at the secret cause 
of disturbance, not only in the sclerotic membranes, but also in 
many of the diseases of the aqueous and vitreous humors of the 
eye. This is now only alluded to, and may form the subject of 
another paper, or will serve to call notice from other medical ob- 
servers. Not less important would be a series of observations as 
regards the action of oxygenated remedies in a high lithic condi- 
tion of the system, as the uric acid might thus be converted into 
urea. In the gouty this change of uric acid into urea might take 
place by the action of oxygenated remedies, and suppuration of 
the synovial capsules and serous membranes ensue, as in rheuma- 
tism, whilst arachnitis and coma form the modes of death, espe- 
cially if kidney disorder exist at the same time. In other cases — 
those in which death is sudden, and the organic lesions are inap- 
preciable or insufficient to account for the fatal termination — the 
urea, by a re- arrangement of its elements, may be converted into 
cyanate of ammonia, thus poisoning the centres essential to life. 

It is not always that in rheumatism there is a deficiency of sur- 
face excretion, nor in gout that the kidneys are chiefly in fault. 
The materies morbi may be generated by the imperfect compos*- 



1858.] On Rheumatism. 117 

tion and quantity of the blood itself, so that the tissues of selection 
cannot be properly nourished, — their structural assimilation being 
more or less destroyed. 

The excretion of soda in tophaceous deposits or articular incrus- 
tations, does not take place in rheumatism as in gout ; it is, how- 
ever, partially witnessed in the hybrid affection, viz : rheumatic 
gout. This in part, may be accounted for ; as in the gouty the 
primary digestion is disturbed, whilst in the rheumatic the secon- 
dary assimilations are more at fault. Hence, the first are apt to 
use soda as a corrective of acidity, or " to bring the wind off the 
stomach ;" whilst, probably, from the inactivity of the liver, the 
alkali from the salt used at table is not called on in the forma- 
tion of bile, and thus collects in the blood. In rheumatism, how- 
ever, we have at times such fusion of the immediate tissues about 
the joints, rendering anatomical division almost impossible, that it 
would seem by the excessive attraction of lactic acid to the parts, 
it possessed the power to act as a solvent of the elementary fibres, 
as I have found it for many years useful for that purpose in dys- 
pepsia of animal substances. 

It is well known that rheumatism more frequently attacks the 
weakly, the intemperate, the irregular in diet (and especially if of 
unwholesome nature,) those who may be exposed to vicissitudes 
of temperature, or who long labor mentally or physically with in- 
sufficient food, or under anxiety and mental depression. But the 
strong, well-fed and able-bodied, young or old, are liable to its suf- 
ferings ; in these, if the exanthemata, or accident, have not engraft- 
ed a kidney vice, and the blood is not overloaded with nitrogen- 
ized products, the attack will be of the simple inflammatory type, 
affecting the nonepithelial fibrous structures or surfaces ; whilst 
heart disease, and especially of the mitral valve, will be infrequent. 
On the other hand, if kidney disease, accidental or exanthematous, 
be present, then structures more important in their uses and ana- 
tomical arrangements, viz : the interior capsular parts, the heart 
and the arachnoid serous membrane, &c, are liable to become af- 
fected, whilst the prognosis is against the patient, either immediately 
or remotely. Delirium or coma, more or less profound, is the dis- 
tinguishing feature in these cases. In the others, where the ex- 
terior cranial fibrous dura mater is attacked, although the suffer- 
ings are intense and the venous suffusion alarming, yet the chan- 
ces to the patient are more favorable, and delirium and coma do 
not follow in so fatal a train if present, unless the effusion be great ; 
and even here, the disturbances are more of position than of nu- 
tritive function. 

The rich or the pampered are not, however, the sole proprie- 
tors of the gout ; the poor, the half-starved have also their gout ; 
it is the offspring of their very poverty. Dives, introduces into 
his blood from without the sreat sources of his evil ; whilst Laz- 



118 On Rheumatism. [February 

arus produces a condition almost similar, by the rapid disintegra- 
tion of his own tissues, loading his ill-fed blood with uric acid and 
other compounds, from the wear and tear of his system. There 
is no compensation by proper supply of food ; and the kidneys and 
other emunctory organs are too enfeebled, though, perhaps, not 
diseased, to extract the uric acid or urea from the blood. These 
cases, though rare, yet take place — it is the gout of the impover- 
ished. They are, in general, inebriate from necessity and from 
physiological instinct; their systems cry aloud for carbon, — for 
liquor, — that the oxygen of the air they breathe shall not burn up 
their pittance-saved bodies, but attack the free carbon and hy- 
drogen of the alcohol, and leave in respite their meagre frames. 
It is the gout of demand and not of supply. And here we find a 
vivid example of the fact above stated, that the tissues suffer dis- 
integration, or death, not only from deficiency of nutritive supply, 
but from defective quality of the blood. In the gout of the impo- 
verished, nitrogenized food — the bane of the rich man — and those 
remedies having the power to retard the decomposition of tissue, 
as tea, coffee, hop, &c, must be trusted in ; and thus the waste 
of the system being restrained, the blood will not be surcharged 
from the structures themselves, and the local disintegration will 
be arrested, and the organs return to their uses ; but mostly with 
deformity as an index of their past trials. 

The urinary deposits, both in gout and rheumatism, sometimes 
mask the condition of urine as secreted by the kidney — the uric 
acid formations being disguised by the alkaline, or earthy phos- 
pates. This is chiefly owing to chronic vesical irritation or in- 
flammation, the muco-pus acting on the urea, and converting it 
into carbonate of ammonia, which precipitates the alkaline salts. 
It is thus that the condition of the urine may be masked by the 
presence of pus, or of a mucoid body, in its rout from the kidneys. 
Indeed the highly acid state of the secretion may be the very 
cause by which the bladder may be irritated. The prognosis in 
these cases depends on the nature of the bladder or kidney irrita- 
tion, the possibility of calculous formation, the recent or long 
previous existence of the affection, &c. 

The space allotted me is nearly exhausted, and will necessarily 
oblige me to condense the chief features of treatment, with a run- 
ning statement on some other points. From the preceeding views 
the treatment almost explains itself. In the acute rheumatism 
of the robust, at whatever age, the seat of attack is in the white 
fibrous tissues, the fever high, attended generally with great sweat- 
ing, the pain and swelling intense, but greater than when the epi- 
thelial jibro-serous tissues are affected. Venesection is rarely called 
for, though by some regarded as not only a mitigator of pain, but 
as instituting a better condition for subsequent remedial action. 
As a lessener of fibrin it is useless — its chief value, if used, being 



1858.] On Rheumatism. 119 

the relief to the vascular tension, and the rather more rapid ab- 
sorption of neutralizing remedies. In my own practice I have 
not used it for many years. The local applications of leeches is 
warrantable, but more troublesome in general than the affection. 
A light antimonial emetic, however, answers more fully the desir- 
ed end, followed, on the subsidence of its action, by an active pur- 
gative of Hyd. chlor. mit., with Ext. Colocynth Comp. The 
advantage of early emptying the bowels is realized, when the in- 
creasing disablement of the joints renders the efforts to rise not 
only agonizing but injurious. The affected parts should be bathed 
with a warm mixture of Potassa-bi-Carb. and laudanum, and af- 
terwards wrapped up in cloths saturated with the solution, and 
covered with oil-silk or rubber, which can be gradually removed 
if the heat is complained of. Potato water, as left after boiling 
the vegetable or its parings, has proved a most soothing applica- 
tion, when freely sponged quite warm over the swollen and pain- 
ful joints, which can afterwards be wrapped up in it, as directed 
for the alkaline wash. The Tinct. Actea Racemosa, in 6 to 12 
drop doses, can be given in or followed by a solution of Nitrate, 
Bi-Carbonate, or Acetate of Potash ; or the Tart, of Potash and 
Soda, if preferred, can be substituted. Frequently, in children, 
the Actea alone serves to cut short the attack after a few doses, 
in conjunction with alkaline fomentations. The necessity for pur- 
ging generally ceases after the bowels have been well moved in 
the beginning. At all events, intestinal irritation is to be avoided. 
It is well to remember that the expectant treatment of acute 
rheumatism is nearly as favorable in its results as the active. 
Colchicum, in the acute attack of the strong, who have deranged 
hepatic action, combined with opium, after due operation from 
the bowels, also forms a valuable remedy. Its purging and emetic 
effect is unnecessary and to be avoided. It is more as a chola- 
gogue and an excretor of lithic acid, than as a specific in rheu- 
matism. Where the liver is already acting freely, it does not 
form an agent of trust, and when frequently employed serves to 
injure the system. Hence the discrepancy as to its value. In 
alkaline combination it is frequently useful. The Nitrate of 
Potash, so much lauded of late, will be found beneficial where a 
high condition of fibrin exists in the blood, its solvent action over 
that element being called for. Otherwise it is no more, and many 
times not so valuable a remedy as the other alkaline salts. It is, 
therefore, not from any specific eliminating power of the rheuma- 
tic poison that is called for, but from its defibrinating action, and 
its value as a diuretic, and its probably converting the lithic acid 
into a more soluble compound, urea. After proper evacuation, 
the Pulv-Doveri, in full doses, will generally, though not always 
produce refreshing sleep and quiet the pain. If found stimulant 
to the brain, watchfulness or flightiness taking place, it either 



120 On Rheumatism, [February, 

must be increased or left off. Opium acts, in many cases, as an 
expeller of the lithic acid — in chronic cases, conjoined with tur- 
pentine, it sometimes causes immense quantities to be evacuated. 

All things considered, time, forms as valuable an element in 
the treatment as the remedies selected. A certain amount of ma- 
teries morbi, and the disposition to its reproduction, has to be bro- 
ken up, and time, sweating, and sometimes urination are at work 
in the process of elimination. Remedies may assist, but if injudi- 
ciously employed they will retard, the patient suffering from both 
disease and doctor. The diet should be unstimulating, meat, 
soups, and jellies avoided, toast and water, with light gruels, being 
the best regulators. As the attack subsides, vegetable diet should 
be adhered to, — the local applications and internal remedies can 
be moderated. Clam soup, and raw salt oysters may, after a time, 
be allowed ; and now, if the blood shows decrease of its red cor- 
puscles, the mild preparations of iron may be cautiously com- 
menced on. If loss of flesh be increasing, coffee and tea will 
prove beneficial as preventers of tissue waste. In the anasarca 
of the debilitated, squill with quinine will be found most servicea- 
ble. 

By these means the immediate re-attack may be warded off, but 
mental quiet and bodily rest are imperative. The supply being 
small, the demand should be lessened. But the low diet system is 
not to be carried too far ; it is well to remember that the fibrin is 
increased in the blood by starvation, as well as by high feeding. 
Rest, however, is absolutely necessary. No blood is to be thrown 
into the parts in and about the joints, by the invitation of exer- 
cise. Even in the very robust, acute rheumatism sometimes at- 
tacks the joints after long-continued and violent exercise. But 
where the parts have been "affected, with the system lowered by 
diet, remedies, and wear and tear from pain and loss of rest, great 
caution as to exercise is requisite ; as other structures, and of 
higher importance, may become involved, and simple acute fibrous 
rheumatism, be merged into an attack of the epithelial bursal and 
synovial membranes of the interior of the joint, besides endan- 
gering the heart, pleura, and other organs, when their liability to 
become engaged was not at first probable. 

It is this small point which makes the utmost watchfulness ne- 
cessary, as regards keeping the system in good general working 
order, and which has made the pathological statements so variable, 
as respects the engagement of the heart in acute rheumatism. 
Every practitioner has observed that, when in the first attack in 
sound persons, the swelling, heat, redness, and pain have been 
very great, the heart is not so liable to become affected, as when 
all the symptoms are more moderate. In some cases, however, 
both the tissues in and without the joint are attacked, and then 
the diagnosis is to be carefully viewed, as the renal disturbance 



1858.] On Rheumatism. 121 

is mostly present, though perhaps later to observation, at the 
time. 

The friction with liniments, whilst the thickning, &c, remains, 
after the subsidence of the acute pain, will be found beneficial. 
The following recipe I am Jn the habit of using ; — 

$ 01. Origon, |i 

OL Lavend. Spicat., . . Iss 

Tinct. Aconite Sat., . . 3 i 

01. Amyg. dulc, ... 3 Hi 

Aq. Ammon. fort., ... 3ii 

YeL, 5ss 

M. 
A light covering, with cotton batting and oil-silk, should be 
applied, unless the heat is complained of. The gradual reduction 
of the envelopes should take place after a time, so that chilliness 
be avoided, which would attend its speedy withdrawal. 

The treatment in chronic fibrous rheumatism has the same 
features, differing more in degree than method, excepting in the 
employment of iodide of potassium in small doses. The system 
is to be carefully watched, exercise is to be judiciously and regu- 
larly taken, the surface made to excrete properly, the bowels to 
be kept soluble but unirritated, sleep should be rather longer than 
in health, as a promoter of insensible transpiration and nervous 
recuperation, whilst stimulant embrocations, oil-silk sweatings, 
and light galvanic applications should be employed to the part. 
The color, quantity, and specific gravity of the urine should be 
watched, as giving evidences of approaching danger, or of increas- 
ing constitutional vigor. 

In the heart complications in rheumatism, the treatment re- 
quires great circumspection. The difficulty of breathing, the 
precordial pain, the out-of-breath manner of speech, the desire to 
be propped up, the increasing effusions into the legs, scrotum, 
chest, or abdomen, with diminished urine and rapid pulse — these 
point out the imminent peril of the sufferer, from which nothing 
but a strong constitution and skillful treatment can save him. 
The drain on the pent-up fluids is to be made through the bowels, 
as the kidneys are generally too occluded, or broken down in 
functional power, to be of any use. The Pulv. Jalapae Comp. 
with Elaterium, or other hydragogues, with digitalis over the 
heart, or internally 3 to 6 drops of the Tinct. Veratrum Yiride 
must be administered, and watched during their operation. Sup- 
port by brandy or champagne must be proportioned to the exhaus- 
tion or nervons necessity, but no more. The stimulous, and not 
the carbon, is wanted now — neither lung nor liver can dispose of 
it. If alcoholic drinks disagree, coffee and camphor can be sub- 
stituted, sometimes with most excellent results. During purlins:.. 
the position of the patient is to he kept unchanged^ or even with iht 



122 On Rheumatism. [February, 

head lower if possible — at all events, he is not to be raised sudden- 
ly — whilst stimulants should be snuffed through the nostrils, &c. 
If these means are successful in reducing the effusions, the kid- 
neys can now be gently invited into action. The palpitation 
sometimes yields, most gratefully to the patient, after the adminis- 
tration of champagne, the carbonic acid serving to allay the irri- 
tability of the heart's action. By conjoining the infusion of the 
wild-cherry bark — or, where its bitter tonic property seems to 
disagree with the stomach, a few drops of the dilute Hydrocyanic 
Acid, — a most happy effect may sometimes be obtained when 
the irritability is excessive. But great caution is requisite in the 
administration of organic sedatives, as will be mentioned further 
on. 

In the convalescence, if the liver still should continue at fault, 
the preparations of iron are to be avoided, as they will serve to 
induce congestion, and lock up the proper secretions of the organ. 
At this period, however, the kidneys will sometimes resume their 
functions, and labor not only for themselves, but, by taking off 
the purpurates and other highly carbonaceous compounds, so re- 
lieve the liver, that the system daily rises refreshed from their 
effects. The urine becomes more and more abundant, and loaded 
with the urates of ammonia and soda. It is here I would parti- 
cularly caution the young practitioner, in his testing the urine 
with nitric, or nitro-muriatic acid, lest he should mistake the 
very copious deposits of the white crystals of lithic acid, for albu- 
men. This I have seen done more than once. The deposit of 
the phosphates by heat, is corrected from wrong interpretation 
on the addition of the acid, which re-dissolves them. This dense 
condition of the urine by the urates of ammonia and soda, is the 
very salvation of the patient. Beware then of administering any 
acid, either alone or in combination with a vegetable or mineral 
tonic, as it will serve to neutralize just so much ammonia and 
soda, and thus prevent the elimination by the kidneys of the very 
lithic acid so poisonous in its action to the general system, but 
especially to the serous membrane of the chest, and of the heart, 
which will be again tortured by the acrid blood into renewal of 
its exhausting efforts, whilst convulsion and coma stand threaten- 
ingly near. 

In the early part of this tumult of the system, when the organic 
force is consuming by the overtask of the functions, I would 
strenuously caution against the abuse of opium, or of any narco- 
tic, to produce sleep or relieve from pain. And I will only reiter- 
ate a maxim which I have before published, and often repeated, 
viz : that in all organic diseases attended with pain and excretory 
impediment, opium and other organic sedatives are to be avoided, 
as, by paralyzing the organic centres, dropsies may collect in the 
cavities. 



1858.] On Rheumatism. 128 

Lemon-juice, in some cases of acute and chronic rheumatism,, 
is at times beneficial, though rarely to be trusted to alone. Yet 
I have seen cases where it seemed to act as a perfect specific. It 
will prove chiefly beneficial in uncomplicated cases, where the 
urea fails in its urinary quantity, and where an excess of ammonid 
exists in the blood. Benzoic acid, in these conditions of chronic 
rheumatism, acts at times most favorably. 

The children of gouty, rheumatic, and dyspeptic parents, are 
prone to a lithic condition of the blood, or at least to its elimina- 
tion by the kidney. It is early marked in them by incontinence of 
urine, or " wetting the bed." Although the heart does not evidences 
organic disease in them, yet its motions are violent and frequent 
whilst crystalline lithic acid is formed in the Urine ; or they are 
variable in their diet and irritable in their dispositions, the urine 
being pale, abundant, but free from lithk? acid deposit 07,'in solu- 
tion. The acid condition of the blood is irritating to the internal 
membrane of the heart, and the contractions are sharp and fre- 
quent. There is a loss of true tone in the system, and rheumatism 
is apt to set in spontaneously, or after violent anger or any undue 
exhaustion, exercise, or exposure. Here, opium forms a most 
valuable remedy from its sedative influence and its power to dis- 
engage the lithic acid from the blood. 

Children given to masturbation, but whose urine alternates 
from lithic to the phosphatic, the intermediate depositions of the 
urates of soda and ammonia taking place, with increase of urea,- 
are also subject to rheumatic attack or pains. Substantial diet, 
with opium at night, is the chief remedy. The furtive look, the 
desire for solitude, the uncalled-for sighing, the vesical irritability,- 
the irregular languor, and the blowing sound in the heart and large 
vessels, with more or less palpitation, will serve to direct suspicion 
to the solitary acts of the patient, which careful watching may 
verify. Organic changes may, and frequently do, establish them- 
selves from these long continued functional disturbances. But it 
is always well to remember, in the disorders of nutrition of the 
heart, that the young are reproducers — their organic desire to re- 
model is ever at work ; that the hypertrophy, if it exist, is mostly 
from interstitial deposit, and not a true fibrillar increase of the 
heart itself. Restraint from the abuse, chemical changes afforded 
to the blood, and the supply of fresh material by proper food, with 
attention to moderation of exercise, and sometimes to complete 
bodily rest, will form not only the treatment, but, in many a new 
organ. Of this I have seen several most excellent examples. In 
later life, an individual ceases to be an active remodeler ; he is 
on the waste account ; his capital has no interest accruing, and 
he is forced to use it up for the common necessities of his sys- 
tem. These are distinctions as well as differences. Had these 
views been more common, so many heart-disturbed children would 

n. s. — vol. xrv. no. n. 6 



124 On Rheumatism. [February, 

not have filled an early grave, or been moored to the stake of life, 
to waste away an aimless existence in later years. 

In scarlatinal rheumatism, all treatment at times is rendered 
impossible by the condition of the patient ; as in scarlatina, the 
do nothing system is frequently the best. Good nursing, attention 
to the skin by sponging or moist wrappings, are better than the 
" nimia diligentia medici." During the fever, the pain is mostly 
in the wrists, or in one or two joints. The scarlatina and the 
rheumatic complication are offspring of the same poison. There 
is pain, as in true fibrous rheumatism, but it is seated in different 
structures, and attended with different implications as regards the 
head, the heart, and the chest. In the robust, the diet, or rather 
the absence of it, forms the treatment. All animal food is to be 
avoided — the blood is yet too overloaded with nitrogenized pro- 
ducts. If too early indulged in, the articular pains recommence 
or' increase, chest or heart difficulties are renewed, and convul- 
sions endanger the life of the patient. Farinaceous and vegeta- 
ble diet must be continued a while longer. The debility is de- 
ceptive ; it is more the result of the oppressive action of urea over 
the great nervous centres, than loss of power from nutritive want. 
The return, then, to animal food, must be cautiously watched. 

But in the weakly, these fears have to be in a measure given 
rap. At the first ingress of the rheumatism, a little abstinence 
may be enjoined ; but after that, the position is different. Death 
by debility would ensue more rapidly than by the disease. It is 
the rheumatism of demand. Food and stimulus must be given. 
Ulcerations — pus makings, about and in the joints, are to be check- 
ed; food and drink must do it; for specific medicines are useless, 
unless quinine, iron and other tonics can be so called. Under a 
lowering plan the coffin is sure to close over the wretched victims ; 
and life to most of us, is better with a stiff leg or disabled joint, 
than the kind attention of an undertaker. 

In the convulsions attending both cases as above stated, the 
directions should be : — for the robust, feet and legs in hot water, 
with head up, or at an easy reclining angle ; for the debilitated, 
the horizontal posture, and no warm bath, but cold water sprinkled 
©n the face and chest, in the order of natural respiration. Here, 
the brain must have blood, though diseased blood it be. From 
the neglect of this simple precaution, I have seen a child killed as 
though struck on the head, — the feet, and not the brain, being 
supplied with blood ! 

In syphilitic, and also in chronic rheumatism, iodide of potas- 
sium acts more than well ; in the former it is almost specific. Its 
combination with colchicum and with opium, may at times be 
required. It is not only diuretic, but possesses the property to 
re-establish assimilative vigor. Small doses, in repetition, act 
more favorably than large doses at longer intervals. 



1858.] On Rheumatism. 125 

In rheumatic gout, especially where the fibrous sheaths of 
nerves are attacked, the combination of Hyd. Pot. with Colchi- 
cum acts most favorably, the Tinct. Aconite Sat., with Acid Hy- 
drocyan. being painted freely over the route of the affected nerves 
and kept from evaporating by strips of oil-silk or rubber. In the 
cranial effusions, the Hyd. Potass, is the most reliable remedy. 

Calomel is chiefly useful as a defibrinator, as a promoter of in- 
terstitial absorption, and as a specific stimulant to the liver, by 
which the decarbonation of the blood shall be promoted through 
the secretion of bile. In the debilitated it is positively harmful, 
if continued; although the balance at times, even in them, may 
be in favor of its use, where the brain is oppressed by black blood.- 

Guaiacum has long enjoyed a reputation in chronic rheuma- 
tism, and with apparent good right. It seems to possess the power 
of increasing the excretion of both lithic and lactic acid, by the 
kidney and skin. In rheumatic dysmenorrhea, in leucorrhoeal 
discharges attending this disorder — in the dermalgia, so painful 
on pressure or warmth — in hysteria and hysteric knee-joint com- 
plaints, mostly of a rheumatic nature, &c, this remedy, in con- 
junction with others, or in the form of the Vol. Tincture, will be 
found serviceable. The cases, however, are to be selected pro- 
perly, whilst time forms an element in its action. I have known 
it not only cure, but eradicate some of these disorders. 

Rheumatic chorea has already been adverted to, with partial 
mention of remedies. The irritability of the heart, or the ner- 
vous propagation is, in many cases, to be quelled before any per- 
manent success can be attained. Arsenic, as in Fowler's solution, 
in six drop doses, with the endermic application of morphine, and 
quinine (if after malarial influence) over the cervical spine, is at 
times very valuable. In the rheumatic form, colchicum and 
aetea racemosa, in small doses, have been found useful. The 
same rheumatic condition of the system haVe been attended, 
in both male and female, with globus hystericus. Stammering, 
as before remarked, is sometimes the result of rheumatism, in 
children whose systems have been Weakened, and who are thus 
more liable to mental emotions, as fright, &c. The heart palpi- 
tates readily, and the muscular nervous branches to the larynx, 
and more rarely the hypo-glossal, or motor of the tongue, become 
the channels of the disordered reflex action. I have many times 
noticed the sudden hesitancy of speech, from sudden emotion, in 
the rheumatic, differing from the arrest of power in the organs 
from emotional acts in the unaffected. 

In conclusion, I shall only refer to acupuncture in sciatica with 
effusion into the sheath, and in muscular pains, having been at 
times serviceable. Chloroform, blisters, the hot button, the ender- 
mic applications of veratrine, morphine, delphine, aconitine, 
strychnine, and other alkaloids, have had reputation for a time, 



126 Exsection of Second Branch of Fifth Pair of Nerves. [February, 

but chiefly in neuralgic affections. In the gouty and rheumatic, 
local applications may relieve temporarily, but it is only by the 
patient study of the blood changes, with the appropriate antago- 
nistic remedies, and food, that any permanent benefit can be real- 
ized, or security against attack be obtained. — [American Med. 
Monthly. 



Exsection of the Trunk of the Second Branch of the Fifth Pair of 
Nerves, beyond the Ganglion of Meckel, for Severe Neuralgia of 
the Face: with Three Cases-. By J. M. Carnochan, Professor 
of Surgery in the New York Medical College, Surgeon -in- 
chief to the State Hospital (New York), etc. 

The accounts heretofore given by authors of neuralgia, or tic 
douloureux of the face, are of a very vague and indefinite char- 
acter. Numerous essays and monographs have been written on 
this subject, since the time of Fothergill r who published,, in 1776, 
an elaborate description of the disease, which attracted consider- 
able attention. In all these efforts,, the pathology of tic doulour- 
eux is described with ambiguity. In practice the treatment 
has been as empirical as it has proved to be unsuccessful. The 
seat of the disease has been referred to distant irritations, espe- 
cially in the splanchnic cavities — to- a foreign body acting upon 
the nerve — to the pressure of bone upon some portion of the 
nervous trunks. By some authorities, it is referred to increased 
vascularity and thickening of the nerves; while Astley Cooper, 
on the contrary, states, that the nerves present their natural co- 
lour, and are rather diminished in size than enlarged. It can 
scarcely be supposed that beneficial results should follow from 
treatmant based upon theories so different in character. 

Tic douloureux of the face, proper, or of the second branch of 
the fifth pair of nerves, is by far the most common form of facial 
neuralgia. This may be explained by the more numerous 
branches, which are given off by this trunk, and by the position 
which these branches occupy — in some places pent up in osse- 
ous canals, and in others subjected to exposure, to changes in 
temperature, as well as to the agency of morbific influences, from 
which the other two trunks of the fifth pair are exempt. 

The same laws which govern neuralgic disease of one of the 
branches of the fifth pair, must be applicable to the disease in 
the other trunks. I believe that the phenomena of neuralgia 
can be explained with as much precision as in any other disease, 
when well understood. In cases similar to those described be- 
low, whatever may have been the original exciting cause, I have 
no doubt that the real seat of the disease is in the trunk of the 
nerve, in front of the foramen rotundum — in some parts of it, or 



1858.] Exsection of Second Branch of Fifth Pair of Nerves. 127 

in the whole of it. The causes of the disturbed and changed 
condition of the trunks of the nerve may be numerous — prolong- 
ed irritation upon the periphery— exposure— injuries— tumours; 
diseases of the teeth — pressure resulting from periosteal or osteal 
thickening of the osseous foramina or canals — sudden suppres- 
sion of any of the important secretions, as of the catamenial dis- 
charge. From one or more of these causes, the trunk itself may 
be primarily affected, or acting upon its ramifications, the irrita- 
tion may be propagated to it. Prolonged irritation induces in- 
flammation, and this generally remains passive or chronic. Some 
of the terminations of inflammation — such as the effusion of 
lymph among the interstices of the neurilemma or the nervous 
tissue itself — may become developed ; leading to a vascular, en- 
gorged, thickened and enlarged condition of the nerve, or to a 
softening of it, at one or more points. In fact, vascular engorge- 
ment, or inflammation, with some of its consequences, of the 
neurilemma alone, or of it and the nerve together, by whatever 
cause produced, is the condition which constitutes the patholo- 
gical changes in the trunk. 

The three cases related below afford proof of what has just 
been stated. In each instance, the exsected nerve was found to 
be red, vascular, engorged and considerably enlarged. 

The diffused character of the pain can be easily understood, if 
we take into consideration the numerous ramifications of the 
second branch of the fifth pair, and the extensive surface over 
which their ultimate filaments are distributed. The periphery 
of the nerve occupies not only the superficial parts of the face, 
but extends deep among the bones of the upper jaw, to the nasal 
fossae, to the septum nasi, to the hard and soft palate, to the phar- 
ynx, to the inner ear, to the orbit, and to the temporal and 
malar regions. 

It is well established, that if the trunk of a nerve be irritated 
along its course, the painful sensation will be referred to its pe- 
riphery. If the ulnar nerve, for example, be struck where it 
passes behind the internal condyle, a sensation of pain is excit- 
ed, which is referred to the little finger and to the ulnar border 
of the ring finger; and if a prolonged irritation be kept up at 
this point, the skin of these fingers becomes tender to the touch, 
the sensibility being very much increased. 

It is by this principle — which governs the action of the stim- 
uli upon the nerves of sensation — in connection with the ana- 
tomical distribution of the nervous ramifications, that the various 
phenomena of neuralgia can be explained. The disease being 
seated in the trunk of the nerve, we can readily understand that 
the pain must be referred to the peripheric extremities of the 
nerves, and will there be felt, as long as the branches are in 
communication with the encephalon. 



128 Exsection of Second Branch of Fifth Pair of Nerves. [February, 

From these views, we can perceive how futile the operation of 
division of the nerve at the foramen infra-orbitale must be f 
Where the trunk of the nerve is extensively diseased, no opera- 
tion can rationally lead to a successful result, unless all the 
branches emanating from the trunk are cut off from communis 
cation with the brain. 

I believe that, in such aggravated cases of neuralgia, the key 
of the operation is the removal of the ganglion of Meckel, or its in^ 
sulationfrom the encephalon.^-Wheie even a large portion of the 
trunk of the second branch of the fifth pair has been simply ex- 
sected from the infra-orbital canal, the ganglion of Meckel con- 
tinues to provide to a great extent the nervous ramifications, 
which will still maintain and keep up the diversified neuralgic 
pains. Besides, the ganglion of Meckel, being composed of 
gray matter, must play an important part as a generator of nervous 
power, of which, like a galvanic battery, it affords a continual 
supply ; while the branches of the ganglion, under the influence 
of the diseased trunk, serve as conductors of the accumulated 
morbid nervous sensibility. 

Case I. — Henry Rousset, a French physician, residing in 
Greenesborough, Caroline County, Maryland, consulted me in 
the early part of October, 1856, for severe neuralgia, which had 
for several years rendered him incapable of following his profes- 
sion. He was of nervous temperament, good constitution, and 
sixty -nine years of age. 

The disease first made its appearance in September, 1851, 
commencing with severe and lancinating pains about the region 
of the left cheek and orbit. These pains continued for five or 
six days, and then disappeared, leaving him almost free from 
them for about four months. At the expiration of that time, 
the neuralgic pains again returned with more violence, extend* 
ing over the region of the left cheek, and continuing almost 
without intermission, for more than a week. After this exacer? 
bation, the patient again became comparatively free from pain 
for a short interval ; after which, the attacks returned with in-r 
creased severity, and were renewed with greater frequency, more 
especially in the cold season, and in damp weather. As the 
disease progressed, the pain was not confined alone to the eye 
and cheek, but would also attack the lip and nose ; each paroxr 
ysm being of longer duration than the preceding. "With but 
slight variation, the disease went on this way to harass and dis* 
tress the patient for four years. About the commencement of 
March, 1856, the neuralgic exacerbation assumed a more violent 
form, marked by excruciating and almost unremitting suffering. 
He was at this time unable to eat, drink, converse, or laugh, 
without having a most violent paroxysm, causing him to shriek 



1858.] Exsection of Second Branch of Fifth Pair of Nerves. 129 

in anguish. The paroxysms were more severe during the night 
than day: sleep left him; his constitution began to give way, 
and his mind became much enfeebled. The slightest touch upon 
the surface of the face, a current of air or a mouthful of water 
acting upon the palate, would throw the patient into a violent 
paroxysm of agony. During this long period of suffering, all 
the known remedies which have at times been extolled for neu- 
ralgia of the face had been tried — narcotics, tonics, antispasmo- 
dics, with counter-irritants, and galvanism, without producing 
any appreciable result. In this distressed condition, the patient, 
wearied of existence and unable any longer to endure a life so 
made up of excrutiating torture, presented himself to me for my 
advice, at the beginning of October, 1856. He expressed him- 
self willing to undergo any operation, however severe, which 
held out the prospect of relief Having no internal remedy to 
propose which had not already been administered, and having no 
faith in the^mere division of the nerve upon the face, I proposed 
to him the exsection of the trunk of the second branch of the 
fifth pair of nerves to a point beyond the ganglion of Meckel. 
Being a physician himself, I explained at length my views (as 
expressed above) in regard to this malady. He immediately 
consented to have the operation performed, and desired that the 
earliest time should be appointed. I consequently agreed to 
perform the operation the following day, the 16th of October. 

Operation. — The principal instruments necessary for this oper- 
ation are a trephine, the crown of which is three-quarters of an 
inch in diameter, an elevator, chisels of different shapes and 
sizes, a leaden or iron mallet, the bone forceps of Luer, small 
pieces of sponge tied to a stick or a piece of whalebone, and a 
small fixed trephine of half an inch in diameter, which may be 
used to perforate the posterior wall of the antrum. The assist- 
ants being properly arranged, the patient was seated upon a 
solid chair, opposite a good light, and was put under the influ- 
ence of chloroform. The head was rested upon the breast of an 
assistant, who maintained it in this position. An incision was 
now made on the cheek, commencing near the internal angle of 
the eye, on the inferior edge of the orbit, opposite the anterior 
lip of the lachrymal groove. This incision was carried down- 
wards and slightly outwards, for about an inch, to a point oppo- 
site to the furrow on the lower portion of the ala of the nose; 
another incision, which also terminated at this point, was made, 
commencing about half an inch below the external angle of the 
eye, opposite the edge of the orbit, thus forming a V incision, in 
the area of which is situated the foramen infra-orbitale. The 
flap thus resulting was thrown upwards, and the branches of 
the second branch of the fifth sought for ; some of these being 
found, they served as a ready guide to the trunk of the nerve. 



130 Exsection of Second Branch of Fifth Pair of Nerves. [February, 

This was now isolated from the surrounding tissues up to the 
point of exit upon the face from the foramen. The lip was now 
everted, and the mucous membrane detached from the superior 
maxilla along the line of junction between the cheek and the 
gum. A sharp-pointed bistoury was now inserted at the apex 
of the Y incision, into the mouth, and carried downwards, so as 
to divide entirely the tissues of the cheek and upper lip, along a 
line passing midway between the ala of the nose and the com' 
missure of the lips, The two flaps thus formed were now dis- 
sected from the osseous tissue beneath, one being reflected out* 
wards, towards the ear, the other internally, towards the nose, 
The whole front wall of the antrum maxillare, with the nerve 
passing through the foramen infra-orbitale, was thus exposed, 
The crown o? the trephine was now applied on the anterior 
wall of the antrum, immediately below the foramen infra-orbitale, 
?md an irregular disk of bone removed, so as to expose freely 
the cavity of the antrum. The circumference of the foramen, 
the hardest portion of the canalis infra-orbitalis, was now des* 
troyed by Iter's forceps, and a small chisel, The trunk of the 
nerve was now traced along the osseous canal in the floor of the 
orbit, which was broken down with care, so as not to encroach 
upon the tissues in the cavity of the orbit, Arriving at the 
back of the antrum, the posterior wall of this cavity was broken 
down with a small chisel, and the portions of bone removed. 
The trunk of the nerve was now still further isolated from the 
other tissues in the spheno-maxillary fossa. The posterior dental 
nerves being divided, and the dissection being carried still fur- 
ther, the branches given off to form the ganglion of Meckel were 
reached, These were divided, and also the branch given off to 
run up towards the orbit, Lastly, by the use of blunt-pointed 
scissors, curved on the flat side, the trunk of the nerve was di- 
vided from below upwards, close up to the foramen rotundum. 
The hemorrhage was not very profuse, the labial arteries being 
easily controlled by pressure of the fingers, and the branches of 
the internal maxillary artery, in the sphenomaxillary fossa, by 
dry lint, or what is better, the compressed sponge. The lips of 
the wound were brought together and maintained in place by 
thirteen points of twisted suture, the German or Carlsbad pins 
being used. 

This severe and trying operation is perfectly justified by the 
fearful nature of the disease for which it was projected. It is 
one of those operations which could not be supported by the 
patient without the influence of chloroform, The handling of 
so large a nervous trunk with the forceps, and the necessary 
contact with the hard instruments, while separating it from its 
surrounding connections^ would, I suppose, be beyond human 
endurance, without the aid of the anaesthetic influence of chloro» 



1858.] Exsection of Second Branch of Fifth Pair of Nerves. 131 

form or ether, For the rest, the effects of the cicatrices upon 
the countenance can scarcely be called disfiguring, and the pa- 
tient speedily recovers without suffering from much constitu- 
tional disturbance. 

In this operation, and in those connected with the two suc- 
ceeding cases, I was assisted by my colleague Prof. Cox, by Drs. 
Proudfoot, Abrahams, Selden, Guleke, and Casseday ; and by 
my pupils, Messrs, Dougherty, Henry, Scudder, and others. 

Condition of the Nerve.— The trunk of the nerve in this case 
was much larger than natural in nearly its whole extent. The 
neurilemma was very vascular, and the nervous tissue proper 
was also engorged and red ; the trunk, after its removal, was so 
red as to have somewhat the appearance of muscular tissue. The 
length of the nerve removed was a little more than an inch and 
three-quarters. The lining membrane of the antrum was sound, 
as well also as the bones of the antrum and the osseous wall of 
the canalis infra-orbitalis. 

Progress of Union and After-treatment. — Oct. lGth. Six hours 
after the operation, the patient was visited. His pulse was 100; 
there was a slight fever ; he complained of thirst, and lemonade 
was ordered. t He spoke of a desire he had to vomit, which he 
ascribed to the chloroform. He stated that he felt slight twitch- 
ings on the nose, and at the corner of the lip, 

17th (Friday). The patient was remarkably well under the 
circumstances; sitting up; pulse 90; tongue lightly covered 
with a white fur ; complained of pain in the wound, also of 
shooting pains in the left eye ; he remarked that he could stick 
a pin into the upper lip and cheek without causing pain, there 
being no sensation in that region. Ordered chicken broth, and 
wine and water. 

ISth (Saturday), Patient improving ; wound healing ; pulse 
natural; no fever; spoke of the numbed sensation in his face. 

19th (Sunday). Pulse full and natural ; good appetite ; par- 
took of a beefsteak; in the afternoon four suture pins were 
removed ; slight pain in the wound ; no return whatever of the 
neuralgia. 

20th (Monday). Cure progressing; healthy suppuration from 
wound ; appetite excellent ; general health much improved. 

(Tuesday, Wednesday, Thursday.) During these days the 
rest of the pins were removed ; patient felt no pain whatever 
either in the wound or cheek; wound in the antrum syringed 
with tepid water, 

25th (Sunday,) Patient attended church ; feels no pain what- 
ever ; incision of the upper lip and cheek entirely healed. 

28th. Patient entirely well. 

30th. Eeturned home to Maryland in high spirits, and deligh- 
ted at the result of the operation. 



132 Exsection of Second Branch of Fifth Pair of Nerves. [February, 

December 7th, 1857. Fourteen months after the operation he 
writes to me that he is enjoying excellent health, and has been 
entirely free from neuralgic pain. 

Case II. — Florence Cordello, a native of Italy, aged 54 years, 
of lymphatic temperament, chocolate maker by trade, was ad- 
mitted to the State Hospital on the 14th of September, 1857, 
suffering from severe lic-douloureux of the left side of the face. 
The following is the account handed to me by the Assistant 
Surgeon, Dr. Guleke. In the year 1828, the patient contracted 
a very severe cold from exposure, and about this time he was 
seized with the pain for the first time. According to his own 
description, the pain started from the foramen infra-orbitale, ex- 
tending upwards to the forehead, and downwards into the teeth ; 
the paroxysm lasting about ten minutes. He supposed it to be 
toothache, and had one or two teeth extracted. An interval of 
eight years took place, when he was again attacked with neu- 
ralgic paroxysms, lasting from five to ten minutes. Again, after 
the lapse of a year, the paroxysms reappeared in a more severe 
form, and at snorter intervals. 

The patient, still believing his teeth to be the source of the 
disease, had all of them extracted on the left side of the upper 
jaw, but without any benefit. During these attacks he had been 
subjected to many kinds of treatment, both internally and ex- 
ternally ; he also repaired to some of the mineral springs on the 
Bhine, but still to no purpose. He continued thus to suffer 
more or less intensely from the neuralgic paroxysms, for a period 
of time extending from 1837 to 1846, and with detriment to his 
general health. In 1846, while passing through the city of 
Heidelberg, in Germany, he consulted the celebrated Chelius 
with the hope of obtaining some beneficial result from his ad- 
vice. That professor divided the nerve as it emanated from the 
infra-orbital foramen, by incisions from the mouth, and six weeks 
after, again performed the same operation, without any favora- 
ble result. During the next six years the patient continued to 
suffer from the neuralgic paroxysms of more or less intensity. 

Oppressed by extreme suffering, he again sought relief from 
an operation, and in 1852 the nerve was again divided from the 
mouth by forcing up the lip ; the actual cautery being at the 
same time applied, by pushing the instrument from the mouth 
upward into the wound as far as the foramen infra-orbitale. This 
operation appeared to give some relief, and during the two suc- 
ceeding years, the patient's sufferings were somewhat alleviated. 
About two years ago, the paroxysms returned in the most aggra- 
vated form, progressed, and continued without much abatement. 
He, on the 1st of September last, being in New York, again 
submitted to an operation for division of the nerve. This time, 



1858,] Exsection of Second Branch of Fifth Pair ofXerves. 133 

the branches of the nerve were divided by cutting through the 
integuments directly upon the infra-orbital foramen ; this oper^ 
ation caused no other effect than insensibility to the touch in the 
soft tissues near the infra-orbital foramen. Two weeks after 
this, he entered the State Hospital The condition of the pa- 
tient was then as follows; Notwithstanding the repeated divis- 
ion of the nerve, there was sensibility to the touch over the 
whole region of the cheek; the inner side of the lip alone ap- 
pearing to be insensible. The patient describes the pain as 
starting from the foramen infra-orhitale and extending up as far 
as the lig amentum palpebral internum, and also to the external 
corner of the eye; from the latter point, the pains shot dow r n in 
nearly a straight line to a point about one inch to the outside of 
the left corner of the mouth, and a little below a line drawn hor- 
izontally on a level with the commissure of the lips. The pains 
also extended backwards, through the more deeply seated por- 
tions of the face, shooting from the inner corner of the eye, along 
the base of the nose, and striking backwards towards the spheno- 
maxillary fossa. The pain was of the true neuralgic character, 
and so intense as to drive the patient into a condition verging 
on delirium. A slight touch on the cheek, the inside of the 
mouth, or on the hard or soft palate, swallowing, or speaking, 
excited almost instantaneously the paroxysms in their severest 
form. 

The operation. — -The operation in this case was performed after 
the same manner as the preceding, and was modified only by 
the greater depth of the antrum and face. There was also 
more hemorrhage from the spheno-maxillary fossa; this was 
controlled by compressed sponge pressed into the fossa. Sup^ 
posing that hemorrhage might return, the lips of the wound 
were brought together by adhesive plaster, one suture only 
being used. The other sutures were inserted the following day. 
The nerve w r as cut from above downwards. The ganglion of 
Meckel was drawn out, hanging to the trunk of the nerve. 

Progress of Union and After-treatment. — Compressed sponge 
was applied in the deeper portion of the wound; the external 
surface was closed with one suture; an anodyne was ordered for 
the night. 

Oct. 11 (Sunday.) Patient slept well during the night; pulse 
76 ; no bleeding ; five suture-pins applied ; ordered an anodyne. 

12th. Patient slept well ; no pain whatever ; pulse 84 ; com- 
plained of thirst ; but little appetite ; speaks and swallows with- 
out pain. 

12>ih. Slept badly; had an attack of dysentery; pulse 96; 
felt a slight pulsating pain in the wound, which, however, was 
doing well ; states that there is no feeling over the surface of the 
left cheek from the inner angle of the eye, descending along the 



134 Exsection of Second Branch of Fifth Pair of Nerves. [February, 

nose to the lip, and upwards to the outer angle of the eye, includ- 
ing the lower lid; ordered opium and quinine. (Afternoon,) 
dysentery subdued ; pulse 96 ; more cheerful. 

L&th. Patient improving ; pulse 92 ; a portion of the pins 
removed. 

15th. Kemaining pins removed; wound presents a healthy 
appearance ; pulse natural ; slight pain felt in the course of the 
wound. 

16^. Eemoved the piece of compressed sponge, which had 
been placed at the back of the antrum during the operation, to 
restrain the bleeding from the spheno-maxillary fossa. 

18^, Patient doing well ; eats well, and sleeps naturally. 

26th. Still entirely free from neuralgic pain ; the whole ex- 
pression of the face changed from that of suffering and anxiety, 
to cheerfulness and serenity. 

28th. Discharged from the hospital entirely cured, and in good 
health and spirits. 

Dec. 8. Visited the hospital ; still free from pain and in good 
condition. 

Condition of the Nerve. — The nerve in this case, as in the pre- 
vious one, exhibited a similar appearance. It was thickened, 
vascular, and engorged. The neurilemma and proper tissue of 
the nerve were both affected. The length of the trunk removed 
was two inches. 

Case III. — Mrs. Mary Gr. Stevenson, a native of Portsmouth, 
England, and who had borne children, 55 years of age, of full 
habit and sanguineous temperament, consulted me in the month 
of September, 1857, for severe neuralgia of the left side of the 
face. She had been a resident of the Northern States for thirty 
years, and had enjoyed generally, remarkably good health. 

On the 12th of August, 1851, while eating a plum in her gar- 
den, she was suddenly seized with a vivid shock of pain, com- 
mencing on her cheek, and passing through her jaw, as if caused 
by a sharp-pointed instrument, suddenly driven through her 
face ; shooting pains of this character, with intermissions of en- 
tire abatement, continued for several days. A dentist was con- 
sulted, who attributing the symptoms to the teeth, extracted 
several of them, but without the slightest benefit to the patient. 
The paroxysms continued with more or less severity for two 
months. 

At the end of this time, they suddenly abated in their severity, 
and the respite lasted for about six weeks. Upon hearing of 
the sudden death of a friend to whom she was much attached, 
the paroxysms were again renewed; they became more frequent ; 
the intervals were shorter, and the intensity of pain was increas- 
ed more and more with each succeeding attack. During the 



1858.] Exsection of Second Branch of Fifth Pair of Nerves. 135 

year 1852, the pain and paroxysms still continued with unyield- 
ing severity. The tic would now last for two and three months, 
with scarcely any of the intervals which had heretofore occur- 
red. Cold air, the drinking of fluids, the slightest touch upon 
the cheek, or any sudden mental emotion, would invariably 
excite the most fearful paroxysms, Daring the year 1854, her 
condition was not in any way ameliorated ; the pain, if possible, 
was more severe, and her general health suffered from the 
want of rest. During the year 1855, the disease progressed with 
the same severity, In the early part of the year 1856, the par' 
oxysms became still more aggravated J the patient, at times, 
becoming almost delirious — starting up, running about her room, 
and screaming like a maniac. In the latter part of September, 
she sought relief from a surgeon in this city, who divided by 
subcutaneous incision the branches of the infra-orbital nerve, 
as it issues from the infra-orbital foramen. 

About this time, she also took large quantities of various nar- 
cotics, and of the carbonate of iron. After the operation, she 
experienced some relief. The amelioration continued from Octo- 
ber, 1856, until May, 1857, when the paroxysms were again 
renewed in their severest form. 

The pain now became almost continual, depriving her nearly 
entirely of sleep ; she was unable to eat without torture, the act 
of swallowing invariably bringing on a paroxysm. During 
these exacerbations, the pain was diffused in different directions, 
extending from a point a little below the infra-orbital foramen, 
or from the ridge of the gums, and striking through the superior 
maxillary bone towards the deeper portions of the face, and 
towards the orbit, and sometimes extending towards the region 
in front of the ear. She described the pain as of a beating 
character at times; each shock succeeding another in rapid suc- 
cession, as if keeping time with the ticking of a clock. During 
this long period of suffering, she had been under the alternate 
care of several physicians ; the various remedies moet approved 
of in this kind of disease had all been faithfully and sedulously 
tried -, stramonium, aconite, belladonna, hemlock, opium, mor- 
phia, chloroform, carbonate of iron, valerianate of ammonia, and 
other medicaments had been administered internally ; while ex- 
ternally, in addition to the division of the nerve, blisters, sinap^ 
isms, hydrocyanic acid liniment, tincture of aconite, and chloro' 
form had beeai resorted to- — also electricity and galvanism. At 
the time I was consulted, she was suffering night and day from 
repeated and excruciating attacks, and, as she herself stated, she 
had visited the city to have an operation performed at all haz- 
ards, however desperate it might be, if I could only hold out any 
prospect whatever of its affording relief. Her general health 
was tolerably good, and she did not complain of loss of appetite.- 



136 Exsectionof Second Branch of Fifth Pair of Nerves. [February, 

I explained to her the nature of the operation which I believe 
to be the only one suited to her case. She immediately assent- 
ed to submit to it as early as possible. 

The operation was performed after the same procedure. The 
face Was in this instance,- also,* very deep. The hemorrhage from 
the spheno-maxillary fossa was considerable, and was stopped 
by a piece of compressed sponge to which a strong ligature was 
attached, by which it could be removed. 

Progress of Union and After-treatment. — Nov. 5. (Thursday 
evening.) As soon as the operation was completed,, the patient 
retired to her bed. Yomiting came on a few hours after, owing,, 
probably, to the quantity of chloroform which had been used. 

6th, Had slept tolerably Well during the night ;■ felt very little 
pain ; pulse 80 ; no fever ; complained of some pain in the 
Wound, but had no neuralgic pain. 

7th. Left side of the face slightly swollen ; puffiness about the 
eyelids ; has no pain ; has slept well without any anodyne ; 
states that she feels better than she has for months; pulse 80;- 
skin natural ;• slight thirst ;• five of the suture pins removed ; 
line of incision looks as though union by first intention was 
going on favorably. Still kept on fluids for nurishment — gruel,- 
rice-water,- ice-water, toast-water, and chicken tea. Ordered a 
gentle aperient. 

8th. Had slept well} tumefaction of face subsiding; com- 
plains of headache ; cloth wetted with cold water applied on 
forehead ; same diet continued ; pulse natural ; removed the 
sponge which was used to stop the bleeding from the spheno- 
maxillary fossa ; this came away without any difficulty by slight 
traction,- a little blood following.- Complains of slight pain in 
the orbit. Eemoved six suture pins, leaving one only— that 
Uniting the free border of the lip.- Fluid diet as before.- 

9th. Patient slept well ; headache less ;• pulse 78 ; no neural^ 
gic pain ; a Weak solution of the tincture of arnica ordered, to 
bathe the cheek with ; removed the last pin ; union by first in- 
tention, along the line of incision, complete.- 

From the 9th Until the 16th all has progressed favorably. No 
neuralgic pain whatever ; sleeps well ;• swelling on cheek dimin- 
ishing; pain has entirely left the orbit ; secretion into the mouth 
from the wound in the antrum diminished. Ordered a gargle 
of the tinture of myrrh. Appetite has also returned. Had 
been sitting up, and walking about her room without any incon- 
venience. Has taken a little sulphate of magnesia ; has not re- 
quired any anodyne. 

Bee. 3. The patient has been progressing favorably up to this 
time. The wound has healed entirely, the line of cicatrix is 
becoming effaced ; not the slightest trace of tic douloureux re- 
maining. There is no paralysis of the muscles of the face upon 
the side operated on. 



1858.] Insanity connected with alleged Criminal Acts. 1#7 

In the case of this patient, the nerve was enlarged, very vas- 
cular, thickened and red. Two inches of the nerve were remc 
ved.[ — American Jour, of Med. Sciences. 



The Lancet, (Dec. 19th,) is rather severe upon Lawyers, oil 
account of their ignorance concerning insanity. Hear what the 
editor says : — [American Med Monthly. 

"On Monday evening, Dr. Forbes Winslow read his paper 
before the Juridical Society,. " On the Legal Doctrines of Kes-- 
possibility in Cases of Insanity connected with alleged Criminal 
Acts.'* There was a much larger attendance at the meeting than 
usual,- the Vice-Chancellor Sir John Stuart being in the chair, 
and amongst the members present was Mr. Bramwell, as well 
as many of the most distinguished members of the bar. This is 
the first time that the attention of lawyers has been directed to 
this important subject by means of a paper written by a medical 
man,- and communicated to a legal society in which free discus* 
sion is permitted;- and we cannot but rejoice that a Way has at 
last been opened whereby the views entertained by the medical 
profession upon what ought to be the legal responsibilities of 
the insane can be distinctly enunciated and tested by that "touch' 
stone of truth," oral discussion. We look upon the proceed- 
ings of Monday night as constituting an era in the history of 
criminal jurisprudence, and we venture to predict that when a 
few more such papers shall have been read and discussed at the 
Juridical Society, it will be impossible for that body to listen 
with common patience to views to which Mr. Baron Bramwell 
gave utterance in the course of the debate on Monday. We 
have always believed that the great differences existing between 
the doctrines of lawyers and medical men on these subjects de- 
pended chiefly on the want of practical acquaintance with insan- 
ity under which the former labor ; but we confess we were 
unprepared for the appalling ignorance of the first principles of 
moral and mental philosophy which was displayed by a lawyer 
who has within the last two years been deemed worthy of ele- 
vation to the bench. In reference to Dr. Winslow's remarks on 
the distinction between the intellectual and moral feelings, Mr. 
Baron Bramwell positively declared that, "for his pari, he doubt- 
ed the existence of moral faculties, or a moral sense /" We are 
acquainted with another learned judge who, on being asked to 
read a well-known medical work on Criminal Insanity, abso- 
lutely declined to do so, stating that he never read anything of 
the sort, and in fact rejoiced in his ignorance. With such mate- 
rials to work upon, progress must necessarily be slow, but it 
will be sure; and the time is not far distant when the judges 



138 Editorial. [February, 

will shrink with as much horror from hanging a lunatic as they 
would now do from burning a witch. Dr. Winslow's paper was, 
as might have been expected, an extremely well-written and 
philosophical essay, and was listened to with a degree of atten* 
tion which, at any rate, argued a desire on the part of the mem* 
bers of the Juridical Society to learn what they could.- It was 
painfully evident, however, from the discussion which followed, 
that the minds of the audience were unprepared to grasp the 
great truths laid before them,- and we therefore hope that the 
author will follow up this paper with another, in which, by 
giving copious details of cases, he may furnish the legal mind 
with a species of food which it can assimilate more readily than 
the recondite truths of psychological philosophy." 



Researches on Arsenic. —Dr. Blofidlot, of Nancy, has just observed a 
fact which explains the contradictions encountered by inexperienced 
chemists in attempts to detect arsenic in connection with organic mat- 
ters.- It is this: — that when substances poisoned have been left to 
putrefy, some sulphuret of arsenic is formed at the expense of the sulph- 
uretted hydrogen, and this, as is well known, escapes detection "by Marsh's 
apparatus. Sulphuret of arsenic also forms when the suspected matters 
are carbonized by the action of sulphuric acid after the process of Flan- 
din and Danger. The sulphuret of arsenic may be extracted by washing 
the carbonized mass with ammonia ; this dissolves the sulphuret ; then 
convert the arsenic into arsenic acid (AsO 5 )' by means of boiling nitric 
acid, so as to obtain a second solution ; this, added to the first, may then 
be tested in March's apparatus. — [Amer. Jour, of Sci. and Arts. 



EDITORIAL AND MISCELLANEOUS. 

Meckel's Ganglion. — In the January number of the Amer. Journal 
of Medical Sciences, we find a paper from the pen of Professor J. M. 
Carnochan, of New York, on the Exsection of the Second Branch (Su- 
perior Maxillary) of the Fifth Pair of ^serves, for the cure of facial 
Neuralgia. On account of the originality of the operation, its uniform 
success, and the heretofore almost hopeless character of this disease in 
certain forms, we have deemed it proper to transfer from that valuable 
quarterly, the entire article to our own pages. The operation proposed, 
and thrice successfully performed, by the distinguished reporter, meets 
with our unreserved approval. If it is objected by any one, that the 
operation is horrible, he can be answered, that it is to eradicate a worse 
than horrible disease, a living and unending agony, to which even death 
itself is preferable, and that the use of chloroform, insisted on by the 



1858.] Editorial 139 

surgeon, removes in a great degree, the strongest objection any one can 
advance against it. 

It is not, however, simply to signify our approbation, that we have 
begun the present notice. Dr. C, in his remarks previous to detailing 
his cases, in endeavoring to account for the success of his operation 
when other modes of procedure had failed — inadvertently, we are con- 
vinced — makes the statement of an opinion in regard to certain points 
in the physiology of the nervous system, which to our mind, with the 
experimental facts before him, should have been given with at least, a 
certain degree of hesitancy, for it involves, either the correctness or the 
incorrectness of news loner held as among the established truths of the 
science. 

After presenting a rapid, but a sufficiently lucid sketch of the many 
forms of facial neuralgia and of the various operations proposed for their 
relief and after reasoning, we think very justly, on the several causes 
operating to produce a continuance or a recurrence of the affection after 
measures taken for its relief, he says : " from these views we can perceive 
how futile the operation of division of the nerve at the foramen infra- 
orbital e must be. When the trunk of the nerve is extensively diseased, 
no operation can rationally lead to a successful result unless all the 
branches emanating from the trunk are cut off from communication with 
the brain. I believe that in such aggravated cases of neuralgia, the key 
to the operation is the removal of the ganglion of Meckel or its insulation, 
from the encephalon. Where even a large portion of the trunk of the 
second branch of the fifth pair has been simply exsected from the infra- 
orbital canal, the ganglion of Meckel continues to provide to a great 
extent, the nervous ramifications which will still maintain and keep up 
the diversified neuralgic pains. Besides, the ganglion of Meckel, being 
composed of gray matter, must play an important part as a generator of 
nervous power, of which, like a galvanized battery, it affords a continued 
supply, while the branches of the ganglion under the influence of the dis- 
eased trunk, serve as conductors of the accumulated morbid nervous 
sensibility." 

Now, the objections which might be urged against the confident state- 
ment of the above theory, are many and various ; some of which we will 
here venture to suggest. In the first place, it is at least questionable, 
whether or not the centres of the Ganglionic System can be productive 
of sensitive phenomena. Secondly : The nervous ramifications, provided 
by the Ganglion of Meckel, are not distributed upon parts where the 
"diversified neuralgic pains are kept up," and especially is this certain, 
after the trunk of the superior maxillary has been removed ; but they 
are distributed to surfaces and parts located internally, as the fauces and 
6* 



140 



Editorial. 



[February, 



the roof of the mouth, to the Schneiderian membrane lining the nasal 
fossse, and probably, conjunctiva cornea, &c. — at least, so anatomical 
investigation and experimental physiology have uniformly determined 
their distribution. 

[We here introduce a cut, from Wilson's Anatomy, which illustrates 
the position and some of the branches and connections of this nervous 
centre.] 




The Cranial Ganglia of the Sympathetic Nerve.— 1. The ganglion of Kibes. 2. The filament 
by which it communicates with the carotid plexus (3). 4. The ciliary or lenticular ganglion, giv- 
ing off ciliary branches for the supply of the globe of the eye. 5. Part of the inferior division of 
the third nerve, receiving a short thick branch from the ganglion. 6. Part of the nasal nerve, 
receiving a longer branch from the ganglion. 7. A slender filament sent directly backwards from 
the ganglion to the sympathetic branches in the cavernous sinus. 8. Part of the sixth nerve in 
the cavernous sinus, receiving two branches from the carotid plexus. 9. Meckel's Ganglion 
(spheno-palatine). 10. Its ascending branches, communicating with the superior maxillary nerve. 
11. Its descending branches, the posterior palatine. 12. Its anterior branches, spheno-palatine 
or nasal. 13. The naso-palatine branch, one of the nasal branches * The point where Cloquet 
imagined the naso-palatine ganglion to be situated. 14. The posterior branch of the ganglion, 
the Vidian nerve. 15. Its carotid branch, communicating with the carotid plexus. 16. Its petro- 
sal branch, joining the angular bend of the facial nerve. IT. The facial nerve. 18. The chorda 
tympani nerve, which descends to join the gustatory nerve. 19. The gustatory nerve. 20. The 
submaxillary ganglion, receiving the chorda tympani nerve from the gustatory. 21. The superi- 
or cervical ganglion of the sympathetic. 

But in the third and last place, the most important objection which 
now presents itself, in our mind, to Dr. Carnochan's ingenious theory is, 
that the results of both experiment and observation are diametrically 
opposed to his deductions. 

The trunks and ganglia and branches, of the ganglionic system, have 
been the subjects of physiological experiment for a period, now extend- 
ing over more than a hundred years; since the year 1*732, when Petit 
made a division of the trunk of the sympathetic in the dog, down to the 
present day, we find ranged along the whole interval, a number of illus- 
trious names, whose multiplied and varied experiments have only con- 
firmed his results, and go to prove that this ganglionic system, has but 
little agency in either sensation or motion, but has mainly confided to it r 



1858.] Editorial 141 

the important and more silent processes of secretion and nutrition. 
Whenever a nervous trunk in any part of this system has been divided, 
in experiment, or a ganglionic centre disturbed or removed, either by the 
knife of the physiologist or in the progress of diseased action, there have 
ever been found, signs of modified nutrition or altered secretion; the only 
modification of sensation, we are aware of, is that observed by M. Ber- 
nard and others, where exaltation of temperature takes place in the parts 
answering to the branches of distribution of the divided nerve, or of the 
ganglion which has undergone evulsion. (See Archives Generates.) So 
much for observations and experiments upon the ganglionic system in 
general. Now let us examine if any experiments can be referred to, as 
illustrating the effect of the disturbance of Meckel's Ganglion in parti- 
cular. There may have been others, but recent research has made us 
more familiar with those of Dr. Alcock, of Dublin, reported in Todd's 
Cyclopedia of Anatomy and Physiology. "We will premise that Dr. Al- 
cock did not draw the same conclusions from the results of his experi- 
ments which we have considered, taking them in connection with analo- 
gous experiments on other portions of the ganglionic system, as unavoid- 
able deductions. He instituted the series to determine, as he says, the 
function of the nerves of Taste ; and yet he more plainly established, than 
any one had done before him, the function of Meckel's Ganglion. In 
order to determine the nerves of taste, he undertook the removal of 
Meckel's ganglion from the dog : he attempted it several times and fail- 
ed at different stages of the operation ; but in almost every case, the eye 
of the same side became bleared within the next two days, a whitish pu- 
riform matter exuded from it, in quantity proportioned to the case ; and 
in one instance in which the ganglion was removed, it actually produced 
opacity of the cornea and ulceration in that structure. 

It will be seen, in the above account, that the effect of the injury or 
removal of Meckel's ganglion was always well marked, and of an entirely 
different character from that which results from injury or section of any 
sensitive nerve. 

Returning now to Dr. Carnochan's Explanation in his history of the 
cases reported ; we find in none of the incidents there related, anything 
which indicates the occurrence of any of those results which uniformly have 
followed upon the evulsion of Meckel's ganglion. — We can account for the 
absence of these sequences on three different principles of reasoning: 

1st. That these results may possibly have obtained in a certain de- 
gree, but Dr. Carnochan regarding them as only the effect of the injury 
(traumatic results) inflicted on the adjacent parts, did not deem them 
worthy of record. Yet, still, the removal of the ganglion should, accord- 
ing to all antecedents, have produced such an amount of perturbation in 



142 Editorial. [February, 

the nutrition and circulation of the eye, as to have compelled his atten- 
tion, and if they were present, he certainly would have reported them. 

2ndly. We might reason that this removal of Meckel's Ganglion in the 
human subject, (not previously performed, so far as we know, by any 
one,) is, perhaps not followed by the same results as when it is experi- 
mentally done in the case of the lower animals, as the dog, <fcc. — This, it 
would be difficult, without farther repetition, to admit ; for the admission 
would strike at the very root of the whole principle of, and destroy the 
confidence on which, Experimental Physiology is based — viz : the identity 
of function in the various parts and organs in man and the lower animals. 

Then, 3rdly, another explanation suggests itself to us, in this dilemma, 
which is, that Dr. Carnochan might possibly have been mistaken in his 
belief, that he had removed the ganglion of Meckel, in the operations 
reported by him. This last, with all the lights before us, would appear 
to us the most probable supposition, were it not, that Dr. C.'s high reputa- 
tion and acknowledged familiarity with the parts in question, which, 
while they have given the subject importance in our eyes, have also ren- 
dered us averse to adopting this remaining supposition as our final 
conclusion. We therefore respectfully leave the conciliation of the ad- 
verse facts, to himself. 

Our object, in the foregoing remarks, has been neither to deny, nor 
captiously to question any conclusions which Dr. C. may have hastily put 
forth in his report of his remarkable operation. These conclusions of 
his are but incidental to the main object of his report, and perhaps no 
considerable amount of importance was attached to them by him, and 
no great thought or trouble expended upon them. They do not, in any 
way, lessen the merit of his operations for the relief of neuralgia. We 
were struck with the remarkable difference in the results reported by 
him, and in those results which have been so long accumulating in the 
records of Experimental Physiology. Perhaps ere this, the discrepancy 
may have occurred to himself, but his manner of referring to this ques- 
tion, so important in a physiological point of view, was such as to leave 
it open for discussion. We have endeavored to do this fairly, and we 
know, in a kindly spirit, carefully avoiding every expression which might 
bear any semblance to disrespectful or uncourteous criticism. 



Physicians and Lawyers. Technicalities before Juries. — We have 
transferred to our pages, an article from The London Lancet, commenting 
upon a paper read by Dr. Forbes Winslow before the Juridical Society, 
" On the Legal Doctrines of Responsibility in cases of Insanity connected 
with alleged Criminal Acts." These comments bear rather heavily upon 
the Legal gentlemen on account of their ignorance concerning Insanity 



1858.] Editorial 143 

in its forensic and other aspects. It is, doubtless, true, that the subject 
of Insanity has received too little attention both from that Profession and 
our own, and we would commend to the attention of all interested in 
such subjects, a work which has recently delighted us, viz., "Mind and 
Matter," from the able pen of Sir Benjamin Brodie. In this work the 
subject of " Moral Insanity," soon to be discussed before the American 
Medical Association, is pertinently touched upon, while many other ab- 
struse points are handled with that philosophic clearness and happy fa- 
culty of illustration, for which this great man is so remarkable. 

We would here remark, with due respect to gentlemen of that learned 
Profession, that we think, upon the whole, Lawyers estimate too lightly, 
the important and intimate relations subsisting between the Science of 
Medicine and their own calling. Medical Jurisprudence, though ably 
taught at the present day in most of our Schools of Medicine, and we 
suppose of Law also, is still a branch, in which much greater excellence 
might most advantageously be sought by both Physicians and Lawyers. 
Nothing so intimidates the young practitioner of medicine, as the appre- 
hension of having to undergo a medico-legal examination ; and yet at 
the same time, nothing can be less pertinent and more irrelevant than 
the questions projected at him on such occasions, by the gentlemen of 
the Bar. They both proceed with great caution. It is delicate ground 
for both; the one is afraid of developing ignorance before the intelligent 
audience usually assembled on such occasions, while the other is afraid 
of developing something which may damage his interest in the case be- 
fore the intelligent Jury. We know from personal experience, that the 
Physician is afraid of the examining Lawyer, and we take comfort by 
strongly opining that the Lawyer is sometimes a little afraid of the de- 
posing Physician. The latter, however, has decidedly the advantage • 
he need only break such ground as he has had the opportunity and the 
precaution to prepare for, previous to the opening of Court. A careful 
study of some work on Forensic Medicine would place them both on a 
level in this latter regard, for then the Physician would soon learn to 
appreciate, as well as the Lawyer, what points in the case, were liable to 
have an important bearing in the evidence about to be elicited, and he 
too, could prepare and brighten up for the approaching ordeal. 

These, however, are -not our only comments; but we deem it prudent to 
premise our remaining remarks by a quotation from that most useful and 
most treasured of all j uvenile journals, " Peter Parley's Magazine." Here, 
many will remember, that in each number, there was a department 
headed — " To our Youngest Readers ;" so in all our remarks on this 
subject, both foregone and to follow, do we address ourselves to our 
" youngest readers." We would ask, then : Are there not faults which 



144 Editorial. [February, 

attach exclusively to our own Profession in its relations to the Courts of 
Justice ? Do we always maintain our dignity and that of our Profession, 
and are our depositions such as will serve most fully in answering the 
ends of justice, by clearing the (so to speak) medical obscurities invest- 
ing it ? — The Lawyers may indeed be deficient in certain attainments 
necessary for the proper administration of Justice in particular cases, 
but we are, also, certainly often greatly at fault, both in the method 
and in the wording of our depositions. We sometimes appear to forget 
entirely that we are not deposing before a body of highly enlightened 
Physicians, but before a Jury, composed of men utterly unfamiliar with 
medical nomenclature and the technicalities of Science. We couch our 
answers in such terms as to render them worse than " meaningless jargon " 
to the Jury, whereas the plainest and most familiar synonyms should, in 
our opinion, be selected to indicate, the organs, their conditions, the re- 
sults of injuiries or of diseases, and, indeed, everything pertaining to the 
point in question. What Jury on Earth, except a jury of scientific men, 
could form any definite idea of the course of a Pistol-ball, for instance, 
which, " after penetrating the integument above the superciliary ridge, 
passed through the external table, diploic structure and vitreous layer 
of the os frontis, then rupturing the three meninges ; — dura mater, 
pia mater and arachnoid, traversed the entire anteroposterior diameter 
of the cerebrum, and in the post-mortem examination, was finally dis- 
covered resting upon the tentorium, in close relation with the torcula 
Herophili ? — Yet pistol-balls, penetrating exactly these structures and 
pursuing precisely the above course, have been known to produce death, 
in cases which afterwards became the subject of medico-legal testimony. 
It would have been more comprehensible to the Jury, and sufficiently 
definite, to have deposed, that; the ball entered the front part of the 
head and passed through the brain, and was found, after death, lodged 
against the back of the head, on the inner side. — Technical terms an- 
swer very well for the records of Science — they give a definiteness and 
an accuracy to our reports, which no other expression can secure; they 
are the language in which the scientific man thinks, and these words 
thus become " the current counters of the mind ;" but in our humble 
opinion, they have no place whatever, unless we intend to mystify, in our 
communications with the uninitiated, and especially have they no place, 
in medical depositions before any ordinary Jury. Simplicity, laborious 
simplicity of language, alone is applicable before the Court. Should we 
inadvertently, or through embarrassment, (for these examinations are 
sometimes very embarrassing,) use a term which is too professional, 
we should hasten to render it into one which can be readily appre- 
hended ; and by pursuing this plan on all such occasions, we have 



1858.] Editorial 145 

little doubt but that, we will secure more confidence and respect for our- 
selves, and maintain a position of greater dignity for our Profession, 
before Judges, Lawyers, Jurymen and lookers-on, than we could gain by 
all the technicalities furnished in all the copies of the whole fifteen edi- 
tions of u Dunglison's Medical Dictionary." 

We may be as " wise as serpents," but we had as well be, as dumb 
41 as serpents." unless we speak in language simple enough to be com- 
prehended by those we address. — We may be like Moses, " learned in 
all the wisdom of the Egyptians," but if we unfortunately employ the 
Egyptian dialect, in which to communicate our thoughts to others, the 
generality of mankind, at the present day, will never be " a whit the 
wiser" for it. Simplicity of language is indicative of meekness, and 
meekness we are told, on the authority of Holy "Writ, qualifies wisdom 
itself; for there it is urged, that, we "show, out of a good conversation, 
our works, — with meekness of wisdom" 

Honors conferred on American Physicians. — We collect from va- 
rious sources, the recountal of Foreign honors bestowed on American 
physicians. We regard such evidences of appreciation as highly import- 
ant, as they not only indicate the favor in which Americans are held 
abroad, but their recountal must have the effect of encouraging our 
younger brethren, and stimulating them to deserve honors even though 
they may never receive them ; — 

" Tis not in mortals to command snccess: 
TVe can do more — deserve it." 

Among the number of those honored with the Emperor of Russia's 
marks of favor, we are gratified to find the name of a graduate of the 
Medical College of Georgia, our friend and fellow-citizen, Dr. W. J. Holt, 
now of Alabama, who has received still another mark of the Czar's distin- 
guished and distinguishing consideration, since the one reported below. 

u Dr. E. B. Turnipseed, now of Xew-York. a native of South-Carolina, 
has recently received from the Emperor, through Baron Stceckel, Puissian 
Minister at Washington, the decoration of the Russian order of St. Anne, 
of the third class, accompanied by two medals attached to the ribbons 
of the orders of St. George and St. Andrew, in acknowledgment of his 
services during the war. The Emperor has also conferred the orders of 
St. George and St. Andrew upon Drs. Harris, Holt. Smith, Eldridge, 
Johnson, and Matthews, all American physicians, who were associated 
with Dr. Turnipseed. 

" The cross of the order of St. Anne is a neat piece of workmanship, 
set in gold and enamel. The decoration of St. George is the highest 
military insignia in the empire, permitted only to those whose live? have 
been risked in the service of the Emperor. The St. Andrew ribbon is 
the highest civil honor. The above facts we gather from the Xew- York 
Daily Times'' — [Surg. Reporter. 



106 Editorial and Miscellaneous. 



Honors for Dr. Jackson. — " We are gratified to record this morn- 
ing, that another honor has been bestowed upon Dr. Charles T. Jackson 
of this city, in token of appreciation of the services which he has con- 
ferred upon humanity as well as science, by his discovery of anaesthesia 
by ether. The King of Prussia has bestowed upon him the cross of 
Chevalier of the Red Eagle, making the fourth order of merit which he 
has received for the same cause, besides one gold' medal. The cross of 
Chevalier of the Red Eagle, sent to Dr. Jackson, is of solid silver, and is 
of the Maltese form. It bears in the centre, on obverse, the figure of the 
red eagle, with shield on breast and a wreath of laurel in his talons, this 
being executed in fine colored enamel. On the reverse, the crown of 
Prussia, over the initials of Frederic William, the King. The cross is 
suspended on a white ribbon, bordered with a broad stripe of cinnamon 
color. 

" We subjoin the letter of the Prussian Minister, notifying Dr. Jackson 
of the new honor conferred upon him : — 

"New York, 30th November, 1857. 

" Sir: — With reference to my letter to you of the 5th of May last, I 
have the pleasure of informing you that his Majesty the King of Prussia 
has been pleased, agreeably to the wish expressed to me in your letter 
of the 18th April last, to confer upon you the order of Chevalier of the 
Red Eagle, as an acknowledgment of your merits in the discovery and 
the application of Anaesthesia. 

" The said decoration I enclose hereby, with the printed ' Thema/ 
marked No. 19,396, which I beg you to fill up by your hand writing, 
and to send it back to me to Washington. 

" I have the honor to be, with high consideration, 
" Your obedient servant, 

"Ferd. Gerolt, 

" Prussian Minister. 
u Chevalier Charles T. Jackson, Doct. of Med. at Boston." 

[Boston Advertiser, Dec. 2. 

Dr. Jackson has recently also had conferred upon him, by the King 
of Sardinia, " the orders of Saints Maurice and Lazarus," in recognition 
of his eminent services to humanity, and the patent and decoration of 
the order have been sent to him. 

" We have certainly every reason to be proud (says the Buffalo Med. 
Journal,) of the appreciation which the services of our countrymen met 
with, during the last war, from Russia and the French. The restless 
spirit of a true American is so powerful that it cannot be subdued even 
by the studies and experiences of medical life, and the opportunities 
open to the medical man for gratifying this propensity, are so few, that 
a war such as the last, is a perfect Godsend. We see this exemplified 
in the numberless applications for appointments in the army and navy, 
where, on this account, the examinations have been made so rigid, and 
the standard of merit has been placed so high, that a comparatively 
small proportion are accepted. Wherever our countrymen go, however, 
they leave the impress of characteristic energy and zeal in doing what 
they have to do, as is exemplified by the gratifying testimonials which 
have been presented to them by the Russian Emperor." 



SOUTHERN 

MEDICAL AID SURGICAL JOUMAL. 

(NEW SERIES.) 

Fol. XIV,] AUGUSTA, GEORGIA, MARCH, 1858. [No. S. 

■ ' ■ ■ ■ , — ; 

ORIGINAL AND ECLECTIC. 

ARTICLE VII. 

The Appropriate Treatment of Dysentery. — A Clinical Lecture, 
delivered at Jackson-street Hospital. By Kobert Campbell, 
A.M., M.D., Demonstrator of Anatomy in the Medical Col- 
lege of Georgia. 

" All practical medicine depends upon a knowledge of three things — to wit : 
1st. Pathology; 2nd, The articles or agents of the materia medica; and, 3rd. The 
relations between these two elements" — [Baktlett's Philosophy of Med. Science. 

Gentlemen : 

In our discussion of the "Treatment of Dysentery," so varied, 
inappropriate and often irrational and incompatible were the 
measures, found to have dominion over this most important and 
common field of interest — that it became necessary for us to 
inquire into their value, as well as the appropriateness of their 
application to the existing state of this disease, and also into the 
probabilities which were derived therefrom, in favor or against 
accomplishing, by them, the relief of that condition. 

And thus, were we obliged to lead you back to "first princi- 
ples," in giving you a common-sense view of these different 
systems, that you might apply the gauge of reason to whatever 
of error or assumption might have obtained sanction in these 
premises, and so be enabled to select from the varied and an- 
tagonistic doctrines in vogue, whatever of good they might 
contain, to the rejection of that which might operate in direct 
opposition to the attainment of the ultimate object in view. In 
n. s. — VOL. XIV. no. in. 1 



108 Campbell's Lecture on Dysentery. [March, 

short, we have thus dwelt, to some extent upon this subject, for 
the express purpose of co-ordinating and systematising the treat- 
ment of this disease. And we have been able to gather, in our 
survey of this field, some facts which were good and fit to garner 
up, but so scatteringly have they been strewn, and so commingled 
have they been with the greater amount of worse than useless 
and pernicious chaff — so much have these principles been found 
to operate to the effect of " blowing hot and cold together" — as 
to call for the exercise of much discrimination and the adoption 
of a system of stern and uncompromising selection. 

Some of the plans of treatment in use — and by far the most 
valuable — we have yet to notice. 

There have been proposed, from time to time, many valuable 
remedies for the relief of this disease — and would it not have 
been remarkable, at this stage of the world's history, if accident 
or experiment had not pointed out the fact, that the exhibition 
of certain medicinals was followed by good results in this dis- 
ease ; and this knowledge had not come in reference to those 
agents, under these circumstances •, empirically ; especially, when 
we consider, that thus, is first derived almost all of our know- 
ledge concerning the action of remedies in general ? 

But in this case, whether from the conflict between a false 
conception of the pathology of this disease and the manifest re- 
sults of these agents; or from the stubbornness of preconceived 
notions in perverting the interpretation of these manifest results, 
it appears always to have happened — that although there has 
been long in use, some appeopei ate teeatment for this disease, 
yet it has existed in such fragmentary parcels, and has been so 
mixed up and incongruously yoked with so much of counter- 
vailing force, as steadily to have maintained, here, an unsettled 
state of our science, or an entire stasis in this particular. 

And this brings us to notice a certain class of remedial 
agents, which constitute what we may call the "appropriate 
treatment" of this, the intestinal element of Dysentery, on ac- 
count of the applicability and the correspondence of their thera- 
peutic action — their specific agency, in supplying the demands 
incident to this diseased state, as determined by the characteris- 
tic qualities of the organ and tissue involved, as well as the 
circumstances in which they are found, and whose abnormal 



1858.] Campbell's Lecture on Dysentery. 109 

condition constitutes this disease ; and especially, as experience 
has taught us, that all or most of this group of remedial agents 
have been found invaluable for the cure of this very disease. 

Let us now return and see, what are the indications, which 
are involved in this local condition, and what are these reme- 
dies, whose specific properties of action, experience has taught 
us to be of that character, which would be best adapted to meet- 
ing the exigencies of this case. We have seen, that there were 
two indications derived from our consideration of the state and 
circumstances of the intestinal element of Dysentery. We will 
now consider them separately. 

First — There is Inflammation of a Mucous Membrane — requir- 
ing ITS OWN PECULIAR TREATMENT. 

Now, the Science of Therapeutics may be said to have been 
based upon the fact, that certain agents, derived from the three 
great kingdoms of Nature, are found to exert a decided influ- 
ence upon the living organism when brought in relation with 
it; and farther, that "they have particular tendencies towards cer- 
tain parts of the body, over which parts they exert a peculiar and 
special influence"* The arrangement of medicines, or their 
classification, is made according to the knowledge of what these 
tendencies are. And, says Headland, (in his recent and very 
valuable "Essay on the Action of Medicines,") "This classi- 
fication is certainly more scientific than a mere empirical ar- 
rangement ; and it will be so far of use, that it will enable us 
when we wish to make an impression on a certain organ or set 
of organs, to select those medicines which especially influence it 

or them There is no doubt whatever," says he, "of the 

existence of these local tendencies or partialities, — their proof," 
he continues, "depending in part upon the fact, that medicinal 
agents are actually detected, in many cases, in the very organs 
over which they exert a special influence." 

It is maintained, on the high authority above quoted — " that 
medicines must (as a general rule) obtain entry into the fluids of 
the body — pass, that is, from the intestinal canal into the system 
at large — before their action can begin" — unless — we would 
suggest — the part to be affected by them be external or superfi- 
cial and their immediate application is thus rendered practicable. 

* Headland. 



110 Campbell's Lecture on Dysentery. [March, 

And just here, we would object to the proposition, as a general 
rule, which requires in all cases, that every particle of all kinds 
of medicines must be absorbed into the circulating mass, before 
they can manifest their peculiar action in the direction of their 
appropriate organ or tissue. For instance, in the case of the 
mucous tissue of the alimentary canal — the very surface upon 
which, as a general thing, all medicines are thrown — why may 
not these agents be applied in sufficient quantity, as not to ad- 
mit of an entire absorption of every particle, to travel the round 
of the circulation and be directed to the same surface by which 
they were taken up, before they can manifest their peculiar 
agency — when their application is primarily and immediately 
made to that superficial surface ? 

The advantage here is, that whilst such a surface is acted upon 
in the usual way, that is — according to this author — by impart- 
ing its impression or influence to the tissue or organ in its transit 
through it, or its elimination by it, (for this is the manner in 
which he accounts for the action of medicines upon secerning 
organs and tissues, generally) ; in this case, the tissue has the 
advantage of its first contact and its transit through it, into the 
circulation, as well as its return through the tissue, to be elimin- 
ated in its proper form, by the mucous follicles of this surface. 
Take, for instance, the action of Turpentine, whose modus 
operandi he explains in the manner just given — Are we to un- 
derstand, that all the Turpentine voided in the alvine discharges, 
has gone the round of the circulation and has been secreted, as 
Turpentine, by the mucous follicles of the intestinal canal? Be 
it so — its operation must be the same, and upon the same tissue. 
But we prefer to believe, that a good portion of it becomes mix- 
ed with, and impregnates, the contents of the canal, and thus 
passes by the shorter route, in contact with, and imparting its 
influence to, this surface. 

But to return — There is, in Dysentery, an inflammation of 
a mucous membrane, REQUIRING ITS OWN peculiar treat- 
ment. 

Now, the treatment of this inflamed mucous membrane is to 
be derived from that class of remedies, unquestionably, whose 
known specific qualities of action, affect the condition of this 
tissue, wherever it exists. Then let us see, what articles of the 



1858.] Campbell's Lecture on Dysentery. Ill 

Materia, Medica, are found to be suitable for supplying the de- 
mands conveyed in the proposition here reiterated. 

There is Ipecac — a " mucous membrane remedy," whose value 
as a remedial agent was first disclosed by the benefit derived 
from its use in Dysentery; and consequently, this has ever 
since been considered, by many, a reliable form of treatment for 
this very disease. 

It is recorded, that " John Helvetius, grandfather of the cele- 
brated author of that name, having been associated with a mer- 
chant who had imported a large quantity of Ipecacuanha into 
Paris, employed it as a secret remedy, and with so much success 
in Dysentery and other bowel affections, that general attention 
was attracted to it ; and the fortunate physician received from 
Louis XIV., a large sum of money and public honors, on the 
sole condition that he should make the remedy public. From 
this period it has maintained its standing among the most useful 
articles of the Materia Medica." 

Dr. "Wood says that — " In Dysentery it has been supposed to 
exercise peculiar powers, but is at present less used than former- 
ly, in doses sufficient to excite vomiting." 

Now, these peculiar powers, we would venture to suggest, are 
alone" dependent upon the specific properties of this remedy, in 
altering the condition of the mucous tissue, wherever it exists — 
this being a disease whose local element is an inflamed mucous 
membrane — hence the benefit derived from its use. And if 
proof of this proposition is demanded, it may be established 
from the experiments of Magendie, with the active principle of 
this agent, from which it was shown " to have a peculiar direc- 
tion to the mucous membrane of the alimentary canal and the 
bronchial tubes. Ten grains of the impure alkali, administered 
to dogs, were generally found to destroy life in twenty-four 
hours, and the mucous membranes mentioned were observed to 
be inflamed throughout their whole extent." And further, it is 
stated, that the "same result took place when emetia was inject- 
ed into the veins, or absorbed from any part of the body." 
And with the same testimony may be placed the effect of the 
inhalation of the powder of Ipecac into the lungs, producing 
bronchitis, as well as its injection into the veins, giving rise to 
pneumonia, as was shown by Magendie's experiments. When 



112 Campbell's Lecture on Dysentery. [March, 

Ipecacuanha is employed in this disease, it is not used as an 
emetic, but as an " anti-dysenteric" — for its introduction into 
the rectum, without causing vomiting, is said to be just as effi- 
cacious as when taken into the stomach ; and that it has been 
found to be most beneficial when tolerated. This tolerance is 
urged by some practitioners to the extent of causing the 
retention of very large doses, without inducing vomiting, even 
3j. doses being administered every two or three hours in some 
cases. 

Although Ipecac is a remedy whose specific properties are 
determined to the mucous tissue, and therefore being appropri- 
ate in its application to Dysentery ; and although it still has 
many advocates — yet there are elements to be derived from the 
same group of agents, to which it belongs, which are less 
objectionable in many respects, and which appear far more 
suitable and are more decidedly efficacious in the cure of this 
disease. 

Now, among this group of remedies, which may be said to be 
rationally specific in this disease, we find also, Benzoin, Balsam 
Copaiba, Creosote, Turpentine and the like — all which are well 
known, rightly to merit a place in this class of remedial agents — 
each presenting sufficient testimony in its favor, to prove its ap- 
plicability to the disease under consideration ; and were all other 
evidences absent, of the ultimate nature of this disease — the fact 
that these remedies, whose operations were manifested in the 
production of certain phenomena, whether under health or dis- 
ease, in the mucous tissues of the body, as found in other situa- 
tions — the very remarkable results of their exhibition in the 
relief of Dysentery, might be taken as rational grounds for de- 
termining the situation and character of this affection. And 
thus might Therapeutics furnish the link and clue in a broken 
and obscure Pathology. 

The tincture of Benzoin, or " Tinctura Benzoini Composita" 
of the Pharmacopoeias has been recommended in doses of from 
f 3ss to f 3ij, as a valuable agent in some of the stages of Dysen- 
tery, and our limited experience of a single case would bear 
testimony thus far, to the validity of its claims to consideration. 
That case was one in which, after a very severe attack of Dy- 
sentery, in an extremely feeble constitution, it became compli- 



1858.] Campbell's Lecture on Dysentery. 113 

cated with Diarrhoea, and the appropriate response to either of 
the indications, manifested in the mixed character of the symp- 
toms, having failed to relieve, or having appeared even to 
aggravate this condition — the plan was adopted of treating the 
inflamed tissue, irrespective of the number and character of the 
discharges, and the effect was magical — the patient, a physician's 
wife, was convalescent very shortly after the change of treat- 
ment, and perfectly recovered. We are aware, that by citing a 
single case to establish any point, we are laying ourselves liable 
to the charge of driving a post hoc, propter hoc conclusion, but 
we give you that isolated fact at what it is worth, supported as 
it is by the commendation of the remedy, by others, based upon 
a more extended scale of experience ; and would advise you to 
bear that fact in mind, to serve you, if ever a similar set of 
complex circumstances as above recounted, should demand its 
application, as the only alternative. 

"We quote from an article* in the London Lancet, the follow- 
ing paragraph, viz. — " When the functions of the colon are 
performed in a healthy manner, the fasces are figured, of a firm 
consistence, and of the well-known color. In Dysentery, or, as 
is sometimes called, colitis, this function is completely in abey- 
ance ; but whether this is produced by the relaxed state of, and 
consequent want of tone in, the muscular coat, or from the ex- 
treme irritability of the mucous membrane of the intestines, or 
of the character of its contents, or all combined, I cannot deter- 
mine. The compound tincture of Benzoin I have found, when 
administered in this disease, particularly useful in restoring, and 
that in a very short time, this- function of the colon. Whether 
it also acts beneficially by protecting and sheathing the ulcer- 
ated portions of the gut, or by its stimulating qualities induces, 
just as it does in chronic ulcers of the surface, the reparative 
processes to go on more rapidly, I am unable to determine. The 
tincture of Benzoin, I need scarcely say, consists of Benzoin, 
Styrax, Tolu, a small quantity of Aloes, and spirit. The dose 
generally given is from fifteen to twenty minims." The writer 
then reports a number of instances in which he had met with its 
striking beneficial effects. 

The marked benefit, so long known to be derived from the 

* On the Treatment of Chronic Dysentery. By R. W. Ellis, M.R.C.S.E., Bristol 



114 Campbell's Lecture on Dysentery. [March, 

application of this balsam, to ulcers and wounds, may have some 
reference to its mode of operation, when applied to the sore sur- 
face of the mucous membrane, in this disease. 

The influence of Balsam Copaiba over the mucous membrane 
lining the urethra is familiar to every tyro in medicine. Ac- 
cording to Pereira, "it also acts as a stimulant, but in a less 
marked manner, to other mucous membranes; namely, the 
bronchial and gastro-intestinal membranes." He states further, 
that " the greater influence of Copaiba over the urethral than 
over other mucous membranes is by some explained thus : — 
Besides the influence which this receives in common with the 
other membranes of the same class, by the general circulation, 
it is exposed to the local action of Copaiba contained in the 
urine, as this fluid is expelled from the bladder. If this hypo- 
thesis were correct, the influence of Copaiba over the mucous 
lining of the bladder would be greater than that over the urethral 
membrane." Now, the fact is here plainly enough enunciated — 
that whilst this group of medicines are classified because of their 
peculiar property of spending their agency upon the mucous 
tissue wherever it exists, there are at the same time individuals 
of this group, which although exerting their influence upon this 
tissue everywhere, yet, having a more decided control over its 
condition in certain parts — owing perhaps to the slight modifi- 
cation of structure in those special localities, dependent upon the 
variable office required of this component tissue to perform, as 
involved in the function of its own complex organ. And it is 
equally true, that some of the members of this class of agents 
are found to be of more restricted, while others are of more 
general, applicability : — i. e., that some, whilst they act on all 
mucous membranes more or less, act upon that tissue in a very 
decided manner, only as it exists in one or two situations — while 
others, operate in a marked degree in all or nearly all its distri- 
butions, as, for instance, is the case with Turpentine. 

J& regards Balsam Copaiba otherwise, than in its special ap- 
plication, Dr. Cullen spoke favorably of its use in hemorrhoids, 
about a century ago. He says, " I have learned from an empi- 
rical practitioner, that it gives relief in hemorrhoidal affections ; 
and I have frequently employed it with success. For this pur- 
pose it is to be given, from 20 to 40 drops, properly mixed with 



1858.] Campbell's Lecture on Dysentery. 115 

powdered sugar, once or twice a day." Since his time, it has 
been used, variously combined, with happy results, in other 
affections of the intestinal canal, as for instance, "in chronic in- 
flammation of the mucous membrane of the bowels, especially of 
the colon and rectum." One of the properties of this medicine, 
as generally laid down in its history, and as is familiar to every 
practitioner, is that of acting somewhat upon the bowels as a 
purgative, or rather laxative. And there are to be obtained, by 
a perusal of the recorded history of practical medicine, glimpses 
of evidence scattered here and there, of the great value of this 
agent in the treatment, not only of the chronic, but of every 
stage of the disease now under consideration. In fact, the term 
chronic, is, for the most part, of arbitrary significance — some de- 
signating such cases thus, which are not relieved, in what they 
consider a reasonable length of time ; while others, especially in 
reference to this disease, apply this qualification to such cases as 
those in which the symptoms are prolonged by persistent ulcer- 
ations in the mucous membrane of the intestine, which owed 
their existence to an attack of Dysentery. 

Dr. LaHoche, in an essay on this subject, bears staunch testi- 
mony to the efficacy of Balsam Copaiba in this disease. As 
likewise does Dr. Meigs, of Philadelphia. This is used accord- 
ing to Eberle's formula, that is, in emulsion made with sugar 
and gum arabic, or dropped upon sugar. A friend of ours, who 
is an intelligent physician, informs us, that he has no other 
treatment for Dysentery than the Balsam Copaiba ; and that his 
success with this agent leaves no room for a desire to improve 
his treatment. 

Such is the written, as well as the un-recorded testimony in 
behalf of this measure ; and although we are not able to bespeak 
its adoption, from our own experience, yet, we must say, upon 
the testimony of others, and considering the acknowledged at- 
tributes of the remedy in relation to our conception of its appli- 
cability to the peculiar requirements of the diseased condition, 
organ, and tissue involved, we would heartily endorse it, as a mode 
of treatment, never to be lost sight of, with reference to Dysentery. 

Creosote has recently gained much advocacy in the treatment 
of Dysentery. It was first used by Dr. Wilmot, as a remedy in 
this disease, in its local application by enema. Thus, it is re- 



116 Campbell's Lecture on Dysentery. [March, 

corded in Banking's Abstract for 1846, that — "In a severe form 
of Dysentery which occurred near Tunbridge Wells, and in 
which all methods of treatment appeared unsuccessful, the mor- 
tality being as high as 25 per cent., Dr. Wilmot thought of 
trying Creosote enemata in the strength of 3j. to fxij. of 
Starch. This remedy produced a speedy amelioration of the 
disease. It will be perceived, that this agent must have acted, 
under these circumstances, for the most part, by its immediate 
application to the diseased tissue. More recently, valuable re- 
sults have been obtained nearer home, and principally in the 
West, from the internal or per orem administration of this 
remedy. 

In our Lecture on the Pathology of Dysentery, delivered in 
November, you will recollect, that we had occasion to quote 
from an article entitled "Creosote in Dysentery," by Dr. Wm. 
H. McMath, which furnished decided proof of the value of that 
agent, in the treatment of this disease. We have just had the 
good fortune to meet with another very excellent contribution 
to the New Orleans Medical and Surgical Journal — " An Essay 
on the ^Etiology, Pathology, and Treatment of Epidemic Dys- 
entery,"* which adds a volume of evidence in favor of the great 
consideration to which this agent is entitled, as a remedy for this 
disease. The author, after dwelling upon the Pathology, &c, 
of the disease, in which we are gratified to find, that some of his 
views are in accordance with our own — viz., in this, that " A 
Dysentery having its origin from the general condition of the 
atmosphere differs from the intermitting and remitting fever 
only in the intestinal affection, and requires a similar treat- 
ment" — then makes the following record of his practice, and 
that of others, upon the same plan — viz : "I have usually open- 
ed the treatment by administering some mild purgative, and a 
favorite one with me has been a combination of Hydrarg. Cum 
Creta and Pulvis Ehei ; assisted, if necessary, with the Syrup of 
Ehubarb. After the action of which, I prescribe the following 
mixture : 

$. — Creosote, gtt. x.; Acetic Acid, gtt. xx.; Sulphate of Mor- 
phine, gr. ij.; Oil of Sassafras, gtt. iv.; Distilled Water, I j.; in 

* By Joseph B. Payne, M. D., of Magnolia, Arkansas. 



1858.] Campbell's Lecture on Dysentery. 117 

teaspoonful doses every three hours, until the discharges are 
checked, and the bowels quieted.* 

If there was any visible remission in the febrile symptoms, I 
usually anticipate that period with the administration of Quin- 
ine. Such is the treatment I have followed, in passing through 
two epidemics, and success has crowned it in nearly every effort. 
I could enumerate case after case where this course has been 
followed, and success the result. I have seen and assisted in 
treating in all, more than two hundred cases of Dysentery. In 
the October number of the Nashville Journal of Medicine and 
Surgery, (page 306,) there is a short article by J. W. Brown, on 
the use of Creosote in Dysentery. He says, " Drs. McMath and 
Gilder, of Louisville, Arkansas, tell me they have treated as 
many as three hundred cases, and in all proving perfectly satis- 
factory, under the use of Creosote." Their prescription, as is 
given by Dr. Brown, is the same as I have given it, except the 
oil of Sassafras, which is an addition of my own, merely to cover 
the disagreeable smell and taste of the Creosote, which it effect- 
ually does. " Now, if there is any honor due to the builder of 
this recipe, and its use advised in the treatment of Dysentery 
(which there undoubtedly is), that honor is due to Professor A. 
P. Merrill, of the Memphis Medical College. I saw him use it 
both in Dysentery and Diarrhoea, with the happiest effects. 
When I returned home, I informed my preceptor, Dr. Gilder, 

* As to " checking the discharges" with an opiate, we think the Doctor is in 
error; and we would here beg leave to object to the Morphine, as an ingredient 
in the Creosote mixture — as we conscientiously believe the indiscriminate and 
unconditional routine of administering Morphine every three hours, to be detri- 
mental — a drawback to the plan of treatment — and that the Creosote in these 
cases manifests its curative powers, in spite of the hindrance. Mr. Headland's 
opinion, as regards certain effects of Opium, is the following : — He says, " Opium 
is a diaphoretic ; but it diminishes all the other secretions, and most especially 
that of the bowels. It is certain that there are other narcotics and sedatives 
which are able to relieve pain, but which neither cause constipation, nor produce 
cerebral congestion." And again, " Opium is a general paralizer to muscular 
fibre, both of the voluntary and involuntary kind, but particularly of the latter. 
And the only reasonable attempt that can be made to explain the action of Opi- 
um in producing constipation, is by a reference to this its paralyzing influence on 
the coat of the bowel, taken in conjunction with the torpid condition of the gen- 
eral system, and suspension of the animal functions, produced by the secondary 
action of this narcotic on the nervous forces." 



118 Campbell's Lecture on Dysentery. [March, 

of the use of Creosote in Dysentery, and we both passed through 
the epidemic of 1855, as above-mentioned. Drs. McMath and 
Gilder have since used it with unequalled success." 

Now, as to the therapeutic properties of this agent — accord- 
ing to Mr. Headland — " Creosote stands, as a medicine, between 
Hydrocyanic Acid and Turpentine. It has a double action; 
being anodyne, like the former ; and a mucous stimulant, like 
the latter." Also, that " Creosote is a sedative, and cannot be 
well given in such large doses as to act upon distant parts." As 
such a practice would be attended with danger. 

It will be perceived from the foregoing, that the treatment of 
Dysentery with this element, from among that class of remedies 
which exert an influence upon the mucous tissue — constitutes it 
an " appropriate treatment" — the . importance of which is suffi- 
ciently established, and it is amply commended to you as such, 
by the recorded results of its wonderful operation. Although, 
from our want of practical experience with the remedy, we can 
furnish no additional support, from our own observation upon 
this subject ; yet, we would have you ever to be mindful of the 
tenor of the commanding testimonials, in relation to the efficacy 
of Creosote in the treatment of Dysentery. 

Now, with reference to the modus operandi of this class of 
agents, Mr. Headland remarks — that " Certain stimulant elimin- 
atives are employed for the purpose of checking mucous fluxes, 
and so far simulate the action of true astringent medicines. Thus 
we administer, with more or less advantage, Aromatics in Diar- 
rhooa ; Cubebs,* Copaiba, and Turpentine in Gonorrhoea ; and 
Balsam of Peru, and other Oleo-resins in Catarrhal affections. 
These medicines may act upon and pass through the glands of the 
several mucous surfaces which they affect ; while so doing, they may 
stimulate the healthy function and secretion of the glands, and cause 
it to displace the morbid one. Dr. Williams thinks that they first 
cause dilatation of the vessels of a gland, and that this is follow- 
ed by contraction. There is no apparent reason why the latter 
effect should succeed the former. But supposing contraction to 
take place in this way, then these medicines would be true as- 

* We see that Dr. Stokes mentions Cubebs, as being a good addition to prepa- 
rations of Balsam Copaiba, when used in Dysentery. 



1858.] Campbell's Lecture on Dysentery. 119 

tringents. But it cannot be so, for they do not diminish any of the 
natural secretions, hut, on the contrary, increase them. Turpentine, 
Cubebs, and Copaiba, are diuretics, and it is possible that while 
passing out in the urine they may simply stimulate the mucous 
surface of the inflamed urethra, and excite it to a healthy action." 
And in speaking of eliminatives again, he further remarks, that 
"it is laid down as a rule, that they act by themselves passing out 
of the blood through the glands, and that while so doing they excite 
them to the performance of their natural function."* And as re- 
gards their ultimate, special influence over the tissue with which 
they come in intimate relation, whether by being applied to its 
surface, or by being eliminated through it — it may, for conven- 
ience, be reduced to the interpretation which attributes it to an 
alterative effect ; for beyond this, any speculation possessed of 
plausibility, will subserve the purposes of explanation : — that is, 
" Alterative, because the manifestations of vital action are some- 
what different after its use from what they were before."f 
Then we would say, that this class of remedies exhibit their bene- 
ficial effects by inducing a healthy change in the condition of that 
tissue, (when under diseased action,) over which, their influence 
is known to have control. 

And now, gentlemen, we rest assured that we are not taking 
too much for granted, when we express the confidence we feel, 
that ere this, your minds are fully persuaded of the truth of the 
proposition laid down to you as the basis of the investigations 
just made — viz., that the rational, the successful, and therefore 
the appropriate treatment of Dysentery, is unquestionably to be 
derived from that class of remedies, which are known to expend 
their activity upon that character of tissue, which is involved in 
inflammation, to constitute the intestinal affection embraced in 
this disease. And we esteem ourselves most fortunate in being 
enabled to adduce such a weight of testimony (which we were 
not aware of until instituting our researches,) to maintain the 
stability of our position, as have been derived from the experi- 
ence of others, with so many of the prominent elements of the 
Materia Medica, constituting this class of remedies. It but re- 
mains for us, now, to supply you with our own humble testi- 

* All these italics are our own. -{-Headland. 



120 Campbell's Lecture on Dysentery. [March, 

mon y, in a farther substantiation of this position, with regard to 
another member of this class — the only one in fact with which 
we have a practical acquaintance in this application — the reme- 
dy, which we prefer to all others, as the safest, the best, and 
most efficient in its operation upon the affections of the mucous 
tissue in general; and which, besides being of the most general 
applicability in the affections of this tissue — is pre-eminently to 
be chosen as the agent for the treatment of Dysentery. This 
remedy is Tukpentine ! 

"We have dwelt to sufficient extent upon the therapeutic 
action of this class of agents, with an occasional reference, by 
way of example, to this one, to render it unnecessary to detain 
you with a repetition of those considerations. The Turpentine 
treatment of Dysentery has long been in use, to some extent, 
popularly, as well as with the profession ; but always so com- 
plicated and obscured by other and antagonistic elements of 
treatment, as to have its benefits lost sight of and very soon, 
perhaps, to fall into disrepute in each particular case. And 
thus, no fixed opinion seems ever to have been entertained as to 
its efficiency and mode of action, and no lasting confidence has 
been established in its reliability as a form of treatment, until 
comparatively recently. 

Some years ago, Dr. John Long, of Pleasantville, Kentucky, 
made the following statement in the St. Louis Medical and Sur- 
gical Journal, viz. — "For more than twelve months past, I have 
been in the habit of using Turpentine in the treatment of Dys- 
entery, as it has occurred in this section of country, and find it 

to be a most valuable remedy in this often formidable disease 

Dose, ten drops, for an adult, every eight hours ; with mucilagin- 
ous drinks and farinaceous diet. I was first induced to resort 
to Turpentine in the treatment of Dysentery, at the suggestion 
of Dr. Wood, of Philadelphia, who recommends it in Typhoid 
fever. During the past summer, I treated thirty cases accord- 
ing to the above method, twenty -nine of which recovered and 
one died ; the latter resided fifteen miles off, and I did not see 
him but once." Some years ago, also, Dr. Wm. C. Brandon, of 
Hermitage, Georgia, through the pages of the Southern Medical 
and Surgical Journal, advocated the use of Turpentine, com- 
bined with Castor Oil, as a treatment for Dysentery. He says, 



1858.] Campbell's Lecture on Dysentery. 121 

"My usual prescription was 1 ounce of Castor Oil with from 1 
to 2 drachms of Oil of Turpentine, for an adult; diminished in 
proportion to the age of younger subjects. Often this dose had 
to be repeated, sometimes twice, before a fecal dejection could 
be procured. The Turpentine was left out in some instances, 
and my opinion is, with disadvantage to the patient. I used 
no saline cathartics, for in every instance where they had 
been used prior to my visit to the patient, I believe they had 
acted injuriously, especially where the stomach and small bow- 
els were implicated to any great extent."* 

And this brings us to consider the Turpentine Treatment, com- 
bined with Castor Oil: as thus united it acts upon the inflamed 
mucous membrane, and at the same time relieves and prevents 
any accumulation in the faecal reservoir, the large intestine, 
which is the seat of this local element of the disease. And this 
is the treatment, of whose adoption and amendment we spoke, in 
our introductory remarks, when considering the u Nature and 
Pathology of Dysentery." And, now, we may here recall to 
your minds with advantage, the Third condition, existing in the 
nature and circumstances of this disease, with its dependent 
indication, viz. — Third. This mucous membrane lines the interior 
of an excretory canal — the seat of the inflammation — WHICH MUST 
BE kept OPEN — it will not do to obstruct it ; for besides the ordin- 
ary and necessary demands of health, that this prima via should 
be unencumbered, and which also has a tendency, (notwith- 
standing all interposed efforts,) to convey its contents onward 
to their exit — if, from any cause, the detritus of the process of 
digestion is detained within its calibre, it would become con- 
crete and consolidated, and would act as an irritating body to 
the inflamed mucous lining — especially as every excited con- 
traction of the muscular coat of this canal, would compress its 
inflamed lining, firmly against this resisting substance, where it 
would probably be held for some time, on account of the loss of 
normal tone in the mucous and muscular coats at this point, and 

* This is a remarkable coincidence of impressions — as regards the action of 
salts in this disease, with our views given while considering that plan of treat- 
ment; and also has some reference to a condition in its pathology, as heretofore 
suggested by us — especially, as we do not recollect to have had our attention 
called to thi« article until now. 



122 Campbell's Lecture on Dysentery. [March, 

would greatly enhance the difficulty — therefore, prevent con- 
stipation. 

Thus, it will be perceived, that the demands of the intestinal 
affection are comprised in the Second and Third indications, 
which may be treated of in connection — the latter being in this 
instance involved in, and forming a necessary condition to, the 
former — that is, whilst the mucous membrane, here, requires the 
treatment appropriate to mucous membranes elsewhere, — here, 
it is besides the lining of an excretory canal, which conveys a 
material of more or less solid consistence ; therefore, it is also 
necessary to combine with that specific treatment, some peculiar 
method of procedure to prevent the irritation of the contained 
solid excrement, in its transit through the inflamed canal — since 
it must pass through ; and this is best accomplished by reducing 
its consistency from a solid to a fluid state, preventing its accu- 
mulation and solidification, and also, by shielding the sore 
surface, if possible, with some emollient or soothing application. 
These two indications, then, together with derivative measures, 
comprise the treatment of the local or intestinal element of this 
disease. 

Now, let us see how far these indications have been fulfilled 
in the following history of our experience as to this disease, with 
our peculiar form of treatment. 

At the time we commenced the practice of medicine — 10 years 
ago — the few sporadic cases of Dysentery which occurred from 
time to time, were treated orthodoxly, or in accordance with 
the most approved modes, prescribed by the text-book authors 
of the day — many of which cases (a large proportion for the few 
that occurred at that time), went their way, secundum artem; 
until Dysentery became an opprobrium to our skill — an incubus 
upon our peace. A year or two afterwards, when the disease 
began to appear epidemically, it became necessary to inquire 
into the respective value of the various suggestions, as regards 
its treatment, which emanated from different sources. If we 
mistake not, it was the London Lancet which first directed our 
attention to the Castor Oil and Turpentine method. About that 
time, we recollect to have been attending a case — an old lady, 
about 60 years of age — the worst case we ever saw, to recover. 
We had been called to her, two weeks after the inception of her 



1858.] Campbell's Lecture on Dysentery. 163 

attack, which she said came on after prolonged constipation, and 
found her in that state, which the complication of age, an appa- 
rently feeble constitution, and the unabated violence of this 
disease, was well calculated to place her. She was on Black- 
berry cordial and Laudanum. The tormina and tenesmus were 
exceedingly violent, the stools very frequent, imperative, irre- 
sistible, and of a purulent character. Altogether, " passing 
away " — as we thought — was impressed visibly, upon every fea- 
ture of this case. . . . "Why hadn't she died? 1 ' — thought we, 
as enormous quantities of opium and astringents foiled to make 

any impression on her disease. "Why doesn't she die?" — 

was the inquiry presented to our minds, when the slightest 
quantity of salts purged her almost to death, without abating, 

perceptibly, the affection of the large intestine. " Why cant 

she die?' 1 — was the pitying interrogation, when she continued 
to vomit small doses of the simple Castor Oil and Turpentine, 
without any relief to her excruciating sufferings. It then, first 
occurred to us, to saponify the Oil with Soda ; to mix in the 
Turpentine; to suspend these in an emulsion of Gum Arabic 
and Sugar ; and to add some Sedative or Anodyne, (which did 
not contain opium); as well as some Aromatic, to cause it to be 
retained by the irritable stomach. The following Kecipe was 
the result — viz: 

$. Castor Oil, Hij. 

Bi-Carb. Soda, 5j. 

Spts. Turpentine, Iss. 

Powdered Gum Arabic, . . . I j. 

Loaf Sugar, 5j. 

Compound Spts. Lavender, . . I j. 

Camphor Water, q. s. to make 8 oz emulsion." 
Flavor with oil of Peppermint or Lemon. 

Of this, she took 1 tea-spoonful every two hours, and the dose 
was gradually increased to 1 table-spoonful, as her stomach was 

* Some of the ingredients in the above recipe may be altered, occasionally, with 
advantage, — for instance, Sweet oil may be sometimes substituted for the Castor 
oil; and the proportion of Turpentine may be varied according to circumstan- 
ces. The Spirit or the Oil of Turpentine may be used indiscriminately. 

About the time we commenced using this recipe for Dysentery, Ave found that 
the same formula, with the Castor oil left out, was an excellent mode of adminis- 
tering Turpentine in Typhoid fever, and have used it ever since. 

7* 



164 Campbell's Lecture on Dysentery. [March, 

able to bear it ; for, after making an effort to retain the first 
dose, the irritability of her stomach seemed rapidly to subside. 
And very soon — being confident of the opposite result — we were 
astonished to see the marked improvement in the condition of 
the patient — who, upon this treatment, steadily advanced to 
recovery — for verily, " her time had not yet come !" 

This Recipe, Gentlemen, has constituted the basis of our inter- 
nal treatment of the local affection of Dysentery, ever since — 
and we have never since found cause to set aside that basis — as 
it has never yet, forfeited the confidence, thus engendered in it. 

We would call your attention to some of the principal ele- 
ments in this formula, and their probable effects under these 
circumstances, to determine how far they rationally fulfill the 
two indications under consideration. 

Now, it will be recollected that, in a former Lecture, we en- 
deavored to show, that there were four elements or conditions, 
making up the sum of that form of disease which is termed 
Dysentery, and that, from these, necessarily proceeded the four 
consequent indications of treatment. 

First. — The existence of Fever, dependent upon a cerebro- 
spinal condition — which was probably the origin of the Dysen- 
tery — demanding the prevention of that fever. Conse- 
quently, on a former occasion, we dwelt to some length, upon 
the great importance — yea, the indispensableness, of giving 
Quinine, as the appropriate remedy for answering this first indi- 
cation, which, together with revulsives, constitutes the treatment of 
the cerebrospinal element of this disease. 

Second. — There being disease of a mucous membrane — re- 
quiring ITS OWN PECULIAR TREATMENT, the action of TURPEN- 
TINE was sufficiently considered, as an appropriate agent, for 
supplying this second indication, and need not be, here, revert- 
ed to. 

Third. — There is Constipation existing and having a tendency 
to persist — being an element of the disease and an obstacle in 
the way of its relief, (because the retained, inspissated contents 
of the canal, constantly irritate the sore surface of the interior 
lining of that canal, over which it must pass) — therefore, the 
third indication was, to relieve and prevent Constipation. 

Now, let us examine into the appropriateness of some of the 



1858.] Campbell's Lecture on Dysentery. 165 

other elements in the formula which we have given you, and 
which are combined with the Turpentine, for the fulfillment of 
this third indication. 

Castor Oil, it is generally accorded, acts principally by lubri- 
cation — i. e., by anointing the interior surface of the intestinal 
canal and allowing substances to pass the more easily over it. 
It is also admitted, that it acts as a mild stimulus to the intestinal 
mucous membrane, inducing mucous stools — and for this reason, 
it is thought principally to act upon the large intestine, as this 
is the characteristic excretion from this portion of the canal. 

The effect of the Soda, which is here combined with the Oil, 
would probably be, first, as a solvent of the faecal mass, and if 
given in large doses, it acts as a laxative. So, may it be per- 
ceived, that the two combined, would probably have the effect 
of overcoming the constipation by their laxative effect, in an inof- 
fensive manner — assisted, if necessary, by exciting the biliary 
secretion with the preparation of Mercury, (viz., Blue Mass and 
Chalk — 1 part of the former to three of the latter,) of which 
we have spoken, as the one we preferred to all others, when the 
obstinacy of the constipation, as well as other indications of 
suspended hepatic secretion, demanded its employment. These, 
together then, may be considered the appropriate treatment for 
the relief of this condition, in answer to the Third indication. 

Some of the secondary effects of the Soda may be considered 
of much benefit in this disease. For instance, in connection 
with Turpentine it proves a most powerful diuretic, and perhaps 
advantageously, as it is known that in all fevers, the secretion 
of this great emunctory is more or less suspended. And if the 
opinion be correct, which has long been entertained, .that in all 
fevers, there is the generation or formation of zymotic elements 
in the system, from the more rapid disintegration of the tissues 
owing to the consequent over-wrought condition of the whole 
organism in that state — the effect of these two powerful diuret- 
ics, as combined in the formula, should serve the valuable pur- 
pose of their elimination from the blood, by the urine. 

And further : May there not be some advantage in the alka- 
line quality of this agent, which may tend to counteract that 
6tate of the fluids of the body, which is favorable for the devel- 
opment and maintenance of that condition, in an important 



166 Campbell's Lecture cm Dysentery. [March, 

portion of the organism, from which results the manifestations 
of this disease? This opinion does not seem so "far-fetched," 
when we are able to refer you to an interesting article, in the 
Dublin Journal of 1848, with the very pertinent caption of 
" Alkaline Treatment of Dysentery" — which is too long to quote 
entire, but where the author* says in relation to one of his case3 
there reported, " The feature of most importance in this case 
was the almost magical effect of the alkali in allaying the tor- 
mina, tenesmus, and purging, the tincture of Opium appearing 
to exert no influence whatever over the disease till combined 
with the liquor Potassae ; the patient remarking, when I visited 
him in the evening, that the last medicine produced a feeling of 
ease and rest from pain quite cheering to him." The writer 
had administered 10 minims of the liquor Potassae every se- 
cond hour, and applied Turpentine to the abdomen. He also 
mentions Soda as one of the alkalies used. 

In several cases, wherein the simple Oil and Turpentine 
were administered, we have to state, that we did not see such 
very remarkable results manifested, or so promptly, as from the 
exhibition of the Emulsion. One of these — a very bad case — 
having been treated by a friend, in the former manner, (when, 
during his sickness or absence, the case fell into our hands,) was 
signally benefited by the change to the Emulsion, and pretty 
soon recovered. 

The Lavender is used here as an anodyne or sedative, devoid 
of any constipating quality — yet, having amply sufficient power 
to allay, in a remarkable degree, the nervous irritability and 
agonizing pangs, consequent upon this torturing disease, by its 
anodyne or sedative influence without a narcotic effect. We are 
aware that this medicine is pretty generally disregarded, as of no 
force, and that it has been consigned to a place among that class 
of medicinal agents, contemptuously designated "Old Women's 
Kennedies;" but it is our opinion, that this class of our race, are 
often the venerable conservators of important, though obsolete, 
medical ideas, as well as valuable, though discarded, medicinal 
agents — and of such, we consider the one in question. There 
is in reason no foundation for an objection to this assertion, on 
the score of " impossibility," in reference to its activity — as the 

* D. Kelly, L. A. Mullingar. 



1858.] Campbell's Lecture on Dysentery. 167 

potent narcotic itself, is but the product of a plant, and that, a 
comparatively delicate and succulent one; and where is the 
sense of denying to this plant, the credit of its own powerful 
virtues ? — We do not pretend to say, that their effects agree in 
kind, but we have long been of the opinion, that the importance 
of this agent, has been very much overlooked. It has been 
long in use for " nervous irritability," "palpitation," " hysteria," 
&c. — and with good reason. We contend, that it might have 
served a valuable purpose, in a more extended application, and 
with more decided evidences of its power: — as, for instance, for 
the purpose of diminishing the irritability of the nerves, conse- 
quent upon the effect of other causes and in other localities of 
irritation. For we know, that under the operation of such 
causes, its continued use has, under our observation, been at- 
tended with remarkable results, which have led us to indulge in 
the projection of an hypothesis, in relation to its therapeutic ac- 
tion, as compared with that of opium. It is this, that while opium 
seems to act upon the central portions of the nervous system, as 
well as the peripheral portions, but more especially upon the 
cerebral mass, inducing a suspension of the functions of this 
organ, in somnolence, coma, &c. — this other plant, may exhibit 
its therapeutic properties, by expending its obtunding influence 
upon the nerves, and, perhaps, the spinal cord, (their more im- 
mediate termination,) without affecting the brain : or, perhaps 
its influence is of a totally different character, and may not be 
manifested in similar results. 

This is but a theory, concocted for our own satisfaction, in 
explanation of the valuable facts, connected with the exhibition 
of this remedy — and whatever be their philosophy, we deem the 
facts have been sufficiently evident to be worthy of remark. 

The tranquilizing effect, which has been generally accorded 
to this vegetable principle, in ordinary doses, is but a moiety of 
the almost paralyzing sedation it is capable of inducing, 
when frequently repeated, or administered in sufficiently large 
doses. That property would seem to be almost identical with 
that of Valerian, and is displayed apparently upon the same 
portions of the nervous system. The tranq uilizing power of the 
latter agent, is plainly to be recognized, in its marked control 
over the subsultus tendinum (if not extreme), of Typhoid fever. 



168 Campbell's Lecture on Dysentery. [March, 

Really, many practitioners seem to have a proclivity for re- 
ducing the practice of medicine to a very simple process — viz., 
the application of a very limited number of medicinal agents — 
by selecting one (the most potent, perhaps,) from each class of 
remedies, and for convenience, striving to force its application, 
under all circumstances, when the demands of all of these cir- 
cumstances, are alone able to be fully supplied from a whole 
class of therapeutic agents — each agent, probably, being adapt- 
ed, from the peculiarity of its properties, to meet one or more of 
the varying phases or stages of pathological condition, which 
may occur in any organ or sj*stem — all which, go to make up 
the manifestations of disease, occurring in any particular organ 
or set of organs, and, perhaps, requiring the employment of the 
whole of that class of medicines, which is known appropriately 
to belong to that organ or system. 

We might adduce numerous instances of the most unmistaka- 
ble and powerful effects, attendant upon the administration of 
the Lavender, as forming an ingredient in the formula, above 
given you, but one or two will suffice for illustration. For ex- 
ample: Mrs. V., an intelligent lady, residing in this place, 
during a very severe attack of Dysentery, in which tormina and 
tenesmus were excessively harassing to her nervous system, 
after taking the Emulsion every three hours during one day, 
was entirely relieved of her dysenteric symptoms, but complain- 
ed bitterly of the paralyzing effect of the "Laudanum Mixture," 
as she called it — saying that, she could not take any more, that 
she "could scarcely raise her hand," and "felt such a calmness 
and lassitude, that it was distressing" to her. It is a common 
thing for patients to call the Emulsion, the " Laudanum Mix- 
ture," or insist that they had been taking Laudanum, from the 
marked relief they experience; and yet, without being particu- 
larly disposed to sleep — their mental faculties being altogether 
unembarrassed. Again: for example — our estimable friend 
and your erudite Professor of Physiology, Dr. Miller, stated to 
us, that on one occasion he was required to administer to a case 
of violent cramp-colic, and there being no other medicine in 
reach, he gave the patient from two to three ounces of this 
Emulsion, and he was entirely relieved, with an astonishing 
promptness. This marked and sudden effect, we could attribute 



1858.] Campbell's Lecture on Dysentery. 169 

to no other element than the Lavender, acting as a powerful 
anodyne, in such quantity. This is an effect pre-eminently 
called for in the nature of Dysentery, and most remarkably ap- 
propriate for its accomplishment here, is this agent, which is 
devoid of a constipating quality. 

The Gum Arabic in the formula, would probably have, only 
an emollient or soothing effect upon the inflamed mucous surface, 
as it may be considered proven — by the experiments of Bous- 
singault, and others, upon fowls, and of Dr. Wra. A. Hammond, 
Surgeon U. S. A., one of the Prize Essayists of the American 
Medical Association, in May, 1S57 — by experiment upon him- 
self — that this gum, as well as others, are entirely indigestible — 
the whole quantity in weight, within a bare fraction of that 
ingested, being collectible from the alvine discharges." 

Now, Gentlemen, having considered the three first indications, 
and also having determined their appropriate requirements, as 
regards internal medication, we have but to refer to an import- 
ant aid for the relief of the intestinal inflammation — viz., that 
of derivative measures. 

\Ye stated before, that if the inflammation existed anywhere 
in the course of the ascending, transverse, or descending colon, 
it might generally be detected by manual pressure along the ex- 
tent of that organ ; but if in the rectum, its situation was to be 
inferred, from the violence of the tenesmus, as well as (when 
used) the intolerance of all enemata. Then, the application of a 
blister, cupping, or leeches, over the tender part, when situated 
in the colon, will be found to be a valuable adjuvant in the 
treatment. We have generally used a small blister, the size of 
the hand, in the more violent cases. This may be kept open, 
with advantage, by poulticing, until the symptoms of the disease 
subside ; or may be placed, alternately, over different portions 
of the canal, which are found, upon examination, to be affected. 
\Ye would deprecate the barbarity of blistering the whole of the 
front surface of a man's body, in order to reach the small portion 
of surface corresponding to the extent of inflamed structure, in 
the interior. "When the disease exists in the rectum, a blister 
applied to the sacrum, will very readily influence it, on account 
of the anatomical position of that organ. AVe have thought that 

* See Prize Essav, in Transactions of Amer. Med. Association, for 1857. 



170 Campbell's Lecture on Dysentery. [March, 

a blister to the sacrum proved the turning point, in an extreme 
case of this kind, where tenesmus was the prevailing symptom. 

We would now notice briefly the requirements of the Fourth 
condition, and its consequent indication of treatment, viz : 

Fourth. There is a state of exhaustion, or, more properly, Fa- 
tigue — Kegular rest and resuscitation of strength are 
TO BE SECURED TO THE patient — by whatever means attainable, 
provided they can be reconciled to the three other obligations to be ful- 
filled — in order to indemnify his vital energies for the effect of 
the harassing influences preying upon them. 

The vast importance of rest, or relief from the racking and 
consuming torture, which we sometimes witness in this disease, 
should be constantly kept in view, or the patient will often sink 
from exhaustion of the vital forces, through neglect in this im- 
portant quarter. We once saw a patient treated on the saline 
plan, which failing to relieve him, he got no rest at night, and 
grew worse every day — until he was allowed some Morphine 
at night — when he slept and appeared much refreshed and re- 
vived the next morning. The Oil and Turpentine Emulsion 
was now substituted for the Salts, when he rapidly recovered. 

A patient with Dysentery should, at all events, be secured 
his accustomed rest at night, by every possible means, that he 
may have the great advantage, so imperatively demanded, and 
so essential to his well-doing, here, of the compensation for the 
damage done during the day, by sleep — 

" Tired nature's sweet restorer, balmy sleep." 

And here is the only appropriate place, which opiates can occu- 
py, in the treatment of Dysentery. With this object, we prefer 
the administration, by enema, of \ to \ gr. of sulph. Morphine, 
in from 1 to 2 ounces of cold water, (as the least irritating pre- 
paration,) every night at bed-time; which may be repeated, if 
necessary, until sleep is induced. It will be perceived that there 
is no danger of restoring the constipation, under these circum- 
stances, so long as is kept up during the day, the unremitted 
application of the other element of the treatment, embraced in 
the exhibition of the Emulsion. 

The patient's strength should also be supported by nourish- 
ment, such as beef essence, chicken soup, corn -meal gruel, etc.; 



1858.] Campbell's Lecture on Dysentery. 171 

for, until the latter stages, general] j, the stomach and small in- 
testines are capable of performing their function of digestion. 
After an attack of Dysentery, it may be of importance to instruct 
the patient to select such articles of diet, as will be favorable for 
preventing constipation, and the consequent re-establishment of 
the disease. Ripe fruit, if in season, will prove often an agreea- 
ble, harmless and very efficient laxative. We remember the 
case of an old lady, about sixty, who, after a very severe and 
prolonged attack of Dysentery, and even before she had entirely 
recovered, regularly ate a cantelope every day, which she con- 
tinued until the season was over for them — her physicians, who 
allowed her the indulgence, recognizing the fact, that the fruit 
could do no harm, as the upper portion of the canal, was not the 
part involved in this disease. 

Xow, Gentlemen, we have seen the full consummation of the 
FOUR indications, which we derived, from the study of this dis- 
ease, in accordance with our plan. We will very briefly reca- 
pitulate the four cardinal points of treatment, as if in connec- 
tion with the management of any particular case. 

1st. Give Quinine, in sufficient quantity, and often enough, 
to break up the paroxysmal character of the disease. Also ap- 
ply sinapisms, or cupping, or a blister to the spine, according to 
the severity of the case, or the degree of spinal irritation present. 

2nd. Commence immediately, and give the Emulsion, every 
hour, or every two, or three, or four hours, according to the 
severity of the symptoms ; for the more intense the symptoms, the 
more often is it to be given, until they are relieved. If the stomach 
is delicate at first, commence with 1 tea-spoonful, and gradually 
increase it to 1 table-spoonful, the ordinary dose for an adult ; 
but give the Emulsion in every case, whatever may appear to be 
the obstacle — and continue to give it, until the patient is quite 
well, diminishing the dose, or increasing the interval, as he re- 
covers. 

3rd. If the constipation has been of long standing, or is ob- 
stinate — probably, from want of action in the liver, as manifested 
by the yellow -furred tongue, tenderness on pressure over the 
right hypochondriac region, &c. — give from 10 to 20 grs. of the 
Blue Mass and Chalk, or moderate doses of Calomel, or Blue 
Mass — though we prefer the former. Also, apply a blister, 

If. s. — VOL. XIV. NO. III. 8 



172 Campbell's Lecture on Dysentery. [March, 

when the case is of sufficient severity, over the diseased portion 
of the canal, to be kept open, or repeated, if necessary. 

4th. If the patient does not sleep at night r give from a quar- 
ter to a half grain of Morphine, in cold water, by injection into 
the rectum, at bed-time every night, and repeat if necessary — 
also have regard to supporting hia strength with nourishment. 

Such is the treatment which we have practiced, in every de- 
gree of Dysentery , from the time of our first commencing the 
use of the Emulsion. And so anxious are we to do justice to a 
measure, in which we have such unbounded confidence, that we 
hope you will pardon us for introducing, here, some evidences 
of its successful application, which are partly derived from our 
own experience, and have partly come to our knowledge from 
its employment by others. 

Should we endeavor to establish its value, by all the testimo- 
ny we could furnish, it would be in effect, but the record of 
every case of Dysentery, which has occurred within that time, 
in our practice, as well as that of your Professor of Anatomy, 
our brother and associate, with the exception of but two, if our 
memory serves us, which did not terminate fortunately — and 
which probably owed their result to the existence of a more 
serious complication. 

But where is the necessity of forcing this testimony from the 
result of our own experience, when all this evidence can be 
furnished from the practice of our professional friends, whom 
we have induced to adopt this mode of treatment, many of 
whom have been long in practice, and are occupying such posi- 
tions as will command for their medical dictum, that confidence 
which admits of no incredulous gainsaying. Many, in this 
place, have adopted this plan ; and in various portions of this, 
and the adjoining States, there are those,, who have for several 
years used, and are still using this, as their only treatment for 
Dysentery. A friend in Alabama, who has an extensive prac- 
tice, informed us recently, that since receiving our letter, recom- 
mending this plan, he has treated all his cases accordingly, and 
although he has passed through a severe epidemic of this disease, 
has not lost a single case. 

Another, in this State, remarked to us, that the overseers 
on the plantations, within the range of his practice, thought it 



1858.] Campbell's Lecture on Dysentery. 173 

necessary, often, only to send to him for a large quantity of 
the Emulsion, on the occurrence of several cases of Dysentery, 
on their places— thus, saving him the trouble of attending. 
From this, it may be judged to be a safe practice. 

And again : we have it from the most reliable authority, that 
a druggist of one of the cities of Georgia, stated, that he had 
prepared and sold during an epidemic of Dysentery, sixteen 
gallons of the Oil and Turpentine Emulsion, according to this 
formula ; and that in this region, it had been peddled about the 
country, as a secret remedy in this disease. And here, gentle- 
men, we would acknowledge, that it was as much the wish, to 
rescue this compound from so illegitimate a prostitution and 
foul perversion of its original design, as anything else, that sug- 
gested to our minds the propriety of making it more generally 
known — and to this end, has it claimed your attention. 

It now remains for us, but to notice that condition into which 
Dysentery often runs, unless timely arrested, and to which we 
called your attention in the latter part of our Lecture on the 
Pathology of this disease— wherein, as we said, the irritation of 
the disease in the large intestine, having been reflected for so 
long a time, upon the upper portion of the primce vice, we see, 
in addition to the purulent or bloody evacuations, a continuous 
and wasting Diarrhcea. Higher up, the stomach becomes in- 
volved in some instances, and there are loss of appetite, nausea, 
and vomiting even of the blandest fluids — together with a red, 
dry tongue, quick and feeble pulse, entire prostration of strength, 
cold extremities and dullness of the mental faculties. And thus, 
the vital spark grows dim, flickers and goes out, unless again 
rekindled by its appropriate stimuli. The nervous system hav- 
ing been over- wrought, loses its excitability— becomes paralyz- 
ed. The mucous membrane of the large intestine, having been 
racked and bruised, remains a passive, purulent, secretory sur- 
face. 

And further — that, in this entire metamorphosis, the charac- 
ters of the original disease have disappeared. It is not Dysen- 
tery, and requires a change of management. It is not Typhoid 
Fever, as shown in its history, and as is manifested, often, by 
the sudden and almost miraculous recovery of cases, upon the 
application of its appropriate treatment. 



174 Campbell's Lecture on Dysentery. [March, 

We can best illustrate this condition and its character, by the 
brief report of the following case— with the facts concerned in 
the history of which, several of our professional friends, in this 
place, are perfectly familiar — viz : 

One of our professional friends, on leaving the city, to be ab- 
sent a few weeks, placed several patients in our hands, and 
among them, Philip — a spare-made mulatto boy, about 20 years 

old, the property of Mr. H , stating, that this patient was 

in the last stage of Dysentery, and would not long trouble us, as 
he was moribund. 

We found him — in complete prostration, with a quick, almost 
imperceptible pulse, red and dry tongue, cold and tremulous 
extremities, mental faculties very obtuse, and occasionally wan- 
dering and muttering; also, passing watery discharges, with 
some pus, involuntarily, and with his stomach rejecting every 
thing, apparently without effort. 

This case had had the full benefit of the Saline treatment. 
We prescribed — Brand}^ to be repeated, until his stomach 
retained it, and then^to be continued without limit. Also, when- 
ever it was apparent that be had had a discharge from the bow- 
els, he was to take, by enema, | gr. Morphine in 1 oz. cold 
water; and perorem, 5 grs. Bismuth (sub-nitrate) in a spoonful 
of cold water. Besides, whenever his stomach could retain it — 
Beef essence and Rice gruel, freely. 

Being now, called away and detained in attendance upon 
the wife of a particular friend, we heard nothing from Philip, 
until about ten days after our visit to him, when we wished to 
be satisfied of the result, and also thought courtesy to our 
professional brother required us to go and express to the boy's 
" owners, our regret for their loss, &a On reaching his room, 
we found it swept out, his bed made up, and a hat lying in 
the floor — unmistakable evidences, to us, of the reality of our 
inevitable convictions. We went to his mistress, stating, that 
we were sorry at not finding the patient where we left him, but 
really expected nothing else, &c. When, without appearing to 
appreciate what we were saying, or even hearing it, she inter- 
rupted us with the interrogation — "Doctor — have you seen 
Philip?" — Imagine our great astonishment, when she continued 
to say — "He was sitting on the steps, but a few minutes ago — I 



1858.] De Witt's Case of Empyema. 175 

suppose he has walked out." — And so he had, and continues to 
walk out and in, to this day. 

And here, Gentlemen, you may take a precept, from the 
memorable injunction of the heroic Lawrence — "Don't give up 
the ship!" — So, never abandon the frail craft of humanity, 
though all the machinery of its proud organization, be o'er-done 
and disabled, with battling against the unequal violence of 
tempestuous disease! — Don't give up this ship — though left a 
wrecked and powerless victim of the storm's furious rage, drift- 
ing headlong toward the boundless ocean of Eternity ! No — 
never give up the wreck — so long as there is any evidence, of a 
human life within it — for God may bless your efforts! 

And now, Gentlemen, in conclusion, having labored to con- 
vince you of the fact, that there is an Appropriate Treatment 
of Dysentery — we hope that you will never be deceived — 
" by the occasional brillianc}' of a few surprising cures, which 
dazzle the minds of men, and blind them to those innumerable 
instances of failure, which ought to teach them the madness of 
confiding in a practice founded upon no rational principle, and 
conducted upon no consistent plan."* 



ARTICLE Till. 



A Case of Empyema, treated by Injections of Water into the Cavi- 
ty of the Pleura. Reported by Sterxes De Witt, M. D., of 
Baker county, Ga. 

When I first saw the case, the patient, which was a girl, aged 
sixteen, had been sick for four weeks — was very feeble and 
much reduced in flesh: pulse quick and weak; had some fever; 
was very restless, could lay no other way than on her left side ; 
breath very short and quick. According to the best informa- 
tion that I could draw from her parents, she was taken with a 
chill after being on the road on a journey five or six days. She 
had been confined to her bed for four weeks — had been laboring 
under febrile symptoms, and had cough, which grew worse ; had 

* Hamilton — History of Medicine. 



176 De Witt's Case of Empyema. [March, 

spit some blood. She had felt considerable pain in her left side, 
which was in the wall of her chest, rather than deep-seated. 
After two days, she had in that locality considerable swelling, 
which, in two or three days, had increased to a remarkable ex- 
tent, reaching as far as the sternum. On one side, and filling 
completely the cellular tissue, around to the spinal column on 
the other side. This, however, did not much alarm the parents. 
In the lapse of about four days more there had formed over the 
false ribs, an abscess about the size of the top of an ordinary 
coffee-cup, having the appearance of an enormous boil. This 
was the state of things when I first saw the patient. 

On examination, I found that the upper swelling was very 
hard ; and at about the third intercostal space the motion of the 
heart could be seen at a distance of several feet — the movement 
communicated to the chest, extending over a space of 3 or 4 
square inches. My attention was next called to the tumor, low- 
er down, which, as I have said, was on the false ribs. This felt 
hard, did not fluctuate, was very red, with little tumefaction 
around it, except in the upward direction ; here I could hardly be 
satisfied that there was any connexion between the two, as the 
swelling was diffused from the axilla half way round the body 
in either direction, and nearly down to the false ribs, on which 
was situated the pointed and more determined tumefaction. 

Being inexperienced, and having never seen a similar affection 
before, I told the parents I would see the case on the next day, 
having determined to operate on the lower swelling, as I had 
no doubt it contained pus ; thinking that it could have no con- 
nexion with the difficulty above, and suspecting the upper 
swelling might, possibly, be an aneurism, of which I knew no- 
thing by experience. 

The abscess, which I had determined to open, had by this 
time got considerably softer and less inflamed. I made an incis- 
ion about three-fourths of an inch long, down to the pus, which 
flowed freely for several minutes. In the meantime, I had no- 
ticed that the upper tumor had wonderfully abated, and the 
breathing had become easier, The matter was quite thin, and 
darker colored than ordinary pus ; this continued to run from 
this opening until the swelling above was almost entirely gone, 
I inquired into the state of the patient's bowels, and found that 



' 3.] De Witt's Oaue of Empyema. 177 

she had not had a passage for several days ; I gave her a gentle 
cathartic, and directed a poultice, which had been used hot, to 
be applied cold. 

I returned on the second day after; the matter had ceased to 
be discharged, and the swelling had increased above, aline b 
much as at first. On examining the lungs by auscultation, I 
found that the patient did not breathe at ail in the left side, and 
that the other lung was laboring under great compression — 
nearly as much so as when I first saw the case ; pulse feeble, 
with some fever. 

The next day, I saw the patient : the swelling had become as 
large as at first, and the breathing very difficult; the pulsation 
in the tumor as apparent as before. I immediately decided to 
let out the matter ; which I did, by making an opening in the 
centre of this pulsating tumor, three-fourths of an inch long. 
The matter flowed in a large stream with such force as to jet 
from the eral inches; this time it did not discharge 

than two quarts of matter in five minutes, and continued to dis- 
charge slowly for several days. In the meantime, I bandaged 
the body and placed a plaster over the opening to prevent the 
ingress of air, removing the same every day, with the patient 
reposing on her knees and breast, thereby aiding the discharge 
of matter, which was materially facilitated by the introduction of 
a small tube through the opening, to expedite the escape of the 
matter, which continued to discharge one or two ounces per day 
for several days, which discharge did not abate as rapidly as I 
had anticipated. 

I prescribed Iron by hydrogen, three grains, three times per 
day. The patient improved, grew stronger, ate heartily, but 
still the discharge did not abate ; the lung did not expand on 
the left side, breathing confined entirely to the right side ; left 
side seemed to lack its fullness, and the spine was flexed lateral- 
ly, the concavity on the affected side. I now tried injection, 
first preparing two quarts of tepid spring water, and with 
Matson's patent injecting instrument, introduced two or three 
inches into the opening — threw the entire quantity of water 
prepared, into the chest, it escaping around the nozzle of the 
ument, after the full ; thus effectually washing 

out the part I afterwards bandaged the body as tight as the 



178 Typhoid Fever : the Thoracic Form — its Treatment. [March, 

patient could tolerate it, applying an adhesive plaster to the 
opening, and permanently closing it. After this, loosening the 
bandage daily. 

On this treatment, the lung began to expand, which continued 
until the function of the lung was entirely restored. The opening 
cicatrized, and the patient was discharged, apparently well. 



Typhoid Fever: The Thoracic Form. Its Treatment By Dr. 
Behier, Physician to the Hospital Beaujon and Adjunct 
Professor to the Faculty of Medecine, Paris. Translated for 
the Southern Med. and Surg. Journal, by J. J. West, M. D., 
Demonstrator of Anatomy in Savannah Medical College. 

The assemblage of symptoms which, in the course of certain 
Typhoid fevers, are manifested on the part of the respirato- 
ry apparatus, known as predominant phenomena, constitutes, by 
common consent, one of the most serious forms of these affec- 
tions. Observed separately in each patient, this form can show 
itself under an appearance more or less distinct, and thus evince, 
not an epidemic, as it has been too often called by an abuse of 
the word, but a peculiar physical constitution. If it is desired 
to study attentively the circumstances in which these sorts of 
constitution are developed, it would be easy to demonstrate, I 
believe, that in the larger number of cases these pathological 
manifestations, thus attributed to a certain number of individu- 
als, ought to be classed among constitutions influenced by sea- 
son, upon which the older physicians insisted so justly, and 
the study of which has been perhaps too much neglected in 
later times and even at present. 

But it is not with this part of the question that I wish to oc- 
cupy myself here ; the part upon which I propose to insist, 
relates to the thoracic form of continued fevers, and is more 
immediately practical. I desire to call attention to a mode of 
treatment which has yielded the most satisfactory results in the 
cases in which I have put it in use, and which has equally well 
succeeded in the hands of another hospital physician, my friend, 
Dr. H. Bourdon, to whom I had mentioned it. It is the appli- 
cation, in great numbers, of dry-cups upon the thoracic parietes, 
and also, and especially, upon the inferior extremities. It was 
in reflecting upon the following observations that I was led to 
the trial of this means : experience has since demonstrated its 
efficacy. 



1858.] Typhoid Fever : the Thoracic Form — its Treatment. 179 

The thoracic phenomena which may be observed in typhoid 
fever are of a peculiar nature, of which it is necessary to render 
an exact account. Exclusive of cases, very rare however, in 
which a phlegmasic complication, a true pneumonia unites itself 
to the primitive pathological element, the disorders that are 
manifested in the pulmonary organs, are nothing less than a 
congestion analogous to that which might occur at different 
parts of the surface. These wide surfaces, of a sombre red, not 
painful, presenting no augmentation of heat, which may be 
observed at diffused points of the skin in subjects attacked by 
typhoid fever, and which sometimes occupies the arm or fore- 
arm, sometimes the face, the nose or cheeks, can, it seems to me, 
explain the mechanism of pulmonary congestions which are 
found, but with a variable degree of intensity, in all the subjects 
attacked by this disease. 

They offer, as cutaneous congestions, the passive character ; 
even the toeight plays a part in its development, to which the 
attention of pathologists has been called for a considerable time. 
These congestions answer, in effect, to that which has been de- 
signated at first under the name hypostatic pneumonia, a designa- 
tion which Prof. Piorry has since modified into that of pneumonia 
hypostatic. At the present time, nothing more is seen in these 
states of the lung than a phlegmasia of the parenchyma, a verit- 
able pneumonia. The diminution of sound observed on per- 
cussion, in almost the whole of the chest behind, and which is 
not enough to constitute a true dullness ("matile"), the rudeness 
of the "bruit respiratoire," which is far from being a bronchial 
souffle, the more marked distinctness of the voice, which does 
not amount to broncophony, and the mucous or subcrepitant 
rales which persist without offering the true character of the 
crepitant, and without passing to the bronchial souffle; all these 
signs, I say, indicate plainly a certain augmentation of the 
density of the luug, but cannot suggest the idea of a true hepa- 
tization. The anatomical examination itself establishes clearly 
the order of lesion to which these signs correspond, and it would 
now be awkward to consider as a proof of a phlegmasia of the 
pulmonary parenchyma, the dark red colour of this tissue, even 
after observing that the lung does not contract upon the opening 
of the chest, as does the lung in a healthy state; that it is a little 
more friable, that it does not crepitate under pressure of the 
fingers, and that it sinks in a vessel of water, instead of swim- 
ming upon this liquid when a small part is subjected to this proof. 
Insufflation, in fact, renders to the lung thus modified, a part 
of its normal appearance, which is impossible in the truly in- 
flamed lung, and shows clearly that if the lung is densified by 
the determination to, and stasis of, a sufficiently considerable 
quantity of blood, there is not in the substance of its tissue any 



180 Typhoid Fever : the Thoracic For m — its Treatment. [March, 

effusion of a plastic nature, the only anatomical character of a 
phlegmasia. Besides, in a case of simple congestion, a direct 
inspection of the incised surfaces permits the recognition of the 
different elements which compose the pulmonary parenchyma — 
elements which, in inflammation, are no longer perceptible, ag- 
glomerated and confused as they are by the plastic infiltration 
which determines the phlegmasia. 

MM. Legendre and Bailly, in insisting upon these distinctions, 
have assuredly rendered a great service to the science. 

The pulmonary lesions observed in typhoid fever, are then, ■ 
the result of a simple congestion, of little intensity in some pa- 
tients, very violent in others, either on account of individual 
disposition, or of a more general influence. This influence may 
even add another element, and in some patients, it is perceived 
that to the congested state mentioned, is added an affection 
of the bronchiae, a kind of capillary bronchitis of which the finer 
rales, and the expectoration of puriform sputa, of almost num- 
mular form, with dyspnoea as the most prominent traits. One 
of the patients that we have observed, and whose history we 
give further on, (obs. 6,) offered an example of this complication. 
When it exists, this catarrhal bronchitis, as it has been called, 
is a new cause of a more considerable congestion in the pulmo- 
nary tissue; it there exaggerates the already existing dispo- 
sition. 

It is when this congestion takes a considerable development, 
whether or not it be exaggerated by the bronchitic element I have 
indicated, that the signs of a pulmonary asphyxia appear — signs, 
the augmentation of which is rarely rapid, but ordinarily gradu- 
al. Among these signs should be mentioned the anxious aspect 
of the face, the bluish coloration of the cheeks and lips, dilata- 
tion of the alae of the nose, more marked dyspnoea, which, how- 
ever, hardly ever increases as far as a state of orthopnea ; it is 
then that the rales are multiplied in the chest, and a danger 
which is immediate and often very difficult to remove, menaces 
the patient. 

The therapeutic indication in such a case is, then, to free the 
lung of blood which flows to and rests there, and serves to ren- 
der this organ too passive to expel the liquids which obstruct it, 
on account of the elasticity which it has lost and which is neces- 
sary to the integrity of its functions. Blood-letting, often prac- 
ticed in like circumstances, removes from the pulmonary tissue 
a part of the venous blood which "accumulates there, but it 
cannot, on one side, be pushed very far without inconvenience 
to the general condition of the patient, always under the influ- 
ence of an adynamic tendency ; and upon the other side, in 
drawing from the patient a part of his strength, these blood- 
lettings tend to augment the passive condition of the lung. 



1858.] Typhoid Fever : the Thoracic Form — its Treatment. 181 

These considerations should tend to banish from practice, in such 
cases, the use of sanguineous abstractions — even the local. It 
has been sought again, to fulfil the indication by disengaging a 
part of the bronchia of their mucosities, by the use of emetics, 
at the same time that tonic preparations, especially those of cin- 
chona, aid in sustaining the advantages obtained with the aid of 
the concussion produced by vomiting. This treatment is assur- 
edly reasonable, but it ought to be limited. Struck with the 
insufficiency of these means, I have sought to aid them, and, in 
considering the mobility of cutaneous congestions in persons 
laboring under an attack of this disease, convinced, above all, 
of the congestive nature of the pulmonary disorders, I found 
myself forced to discover a means of disgorging the lung — a 
means not borrowed from a spoliative therapeutics, and only a 
simple means of displacement. 

I at first thought of employing the Junod cup ; but besides 
its never being procured with promptness in our hospitals, it has 
the inconvenience of easily producing syncopes, accidents which 
might be attended by the saddest consequences in the patients 
we have to treat. It was then that I attempted the application 
of dry-cups, placed in considerable numbers on the chest, and 
particularly upon the inferior extremities. I have gone so far 
as to apply on one patient from 60 to 80 of these cups, morning 
and evening. The evening application is necessary, for oppos- 
ing the return of the congestion removed momentarily by the 
derivation already exercised in the morning; and this tenacity 
of action is not too much against a disposition equally tenacious. 
Under the influence of these cups may be observed very large 
ecchymoses, which are formed in the places where the cups had 
been placed. These ecchymoses persist during a time more or 
less long, but I have never seen them followed by any accident 
whatever, although upon some patients the nnmber of cups has 
been more than 500 in ten days. iNever have I seen gangrene, 
nor even suppuration, against the presence of which evils I have 
always prepared myself, especially in my first trials of this 
means, which was two years ago. I desired to wait some time, 
and to multiply experiments, before publishing the utility of this 
mode of treatment. 

The following facts will serve as examples in confirmation of 
what I have advanced : 

Observation I. — Typhoid. Fever, of the thoracic form, in a 
young woman; emetic ; 120 dry-cu])s in three days. Cure rapid. 

Nickley (Sidonie), 20 years, a servant, unmarried, habitu- 
ally well regulated, has never borne children, has never had 
any other disease than the measles. Actual affection com- 
menced May 12th ; its accession was slow ; the patient had pain 



182 Typhoid Fever : the Thoracic Form — its Treatment. [March, 

in the head ; strength diminished ; at the commencement she had 
a slight diarrhoea and a little cough ; difficulty of respiration 
during several days. She has had no treatment, and has not 
even remained in bed until her entrance into the hospital, the 
20th May, 1855. 

May 21st. 104 pulsations per minute, pulse small, tolerably 
hard ; skin hot, face red, cheeks and lips bluish ; eyes promi- 
nent, humid ; extreme difficulty of respiration ; sound of the 
chest normal ; mucous and sonorous rales very abuhdant on 
both sides, especially at the base of the lung behind ; tongue a 
little shining; loss of appetite ; abdomen slightly enlarged ; gar- 
gouillement in the right iliac fossa; no diarrhoea; some rose- 
colored lenticular spots disseminated upon the abdomen and 
lower part of the thorax ; head heavy ; great muscular debility. 
Prescription: 15 grs. pulv. ipecac; sinapisms upon the inferior 
extremities. 

May 22nd. Has vomited well; two stools; 112 pulsations, 
small; extreme difficulty of respiration ; sound of chest less nor- 
mal, without real matite ; expectoration of white mucus; some 
rales in whole extent of the chest; face and integument of the 
hands still violet ; she breathes better in the almost sitting pos- 
ture she has been made to assume. 15 grs. ipecac, 40 dry-cups 
upon the thorax. 

May 23rd. Abundant vomiting of colorless mucous matter. 
Oppression has greatly diminished since the application of the 
cups; the skin is still of the same dark red color; headache less; 
abdomen soft; skin cool; has a little appetite; 110 pulsations, 
small and hard. 15 grs. ext. cinchona, 40 dry-cups. 

May 24th. Sound of the chest perfect ; still a few rales at the 
base behind; pulse small, sufficiently developed ; skin cool; face 
less colored and less anxious; she regains her natural express- 
ion. 40 dry-cups, lichen two portions, 23 grs. ext. cinchona. 

May 25th. From this time the patiect does well; appetite 
has returned; the skin and mucous membranes lose iiioir yiolet 
hue ; the respiration is natural ; abdomen soft ; bowels quiet ; 
no more headach ; and the 3rd June the patient eats her full 
allowance. 

This observation offers, at the same time, an example of the 
predominance of thoracic phenomena, and the rapid effect of 
dry-cups applied in great numbers. The thoracic form was so 
plainly the predominant element, that once this order of acci- 
dents was removed, convalescence was rapidly established. 

Observation II. — Typhoid Fever, with adynamic state — pre- 
dominance of thoracic symptoms ; 4 cups {scarified) ; 160 dry-cups; 
extract of cinchona ; cure. 

Jette (Francois), 28 years, brick-layer, enters hospital Oct. 16, 



1858.] Typhoid Fever : the Thoracic Form — its Treatment. 183 

1855, "Salle Beaujon/' Xo. 62 : Says he had the same disease 
five years since ; remained about two months in the Brick-lay- 
ers ward, "hospital Beaujon ;" has lived at Paris since he was 
8 years of age. For the last fifteen days has kept his bed with- 
out calling a physician or doing anything for himself; has had 
severe diarrhoea — no epistaxis. This period had been preceded 
by a state of general debility and occasional giddiness, which, 
however, still permitted him to work. 

Oct. 17th. 120 pulsations, pulse small; skin hot; violet co- 
lor of the skin, especially of the face and extremities; lips 
violet ; nares dusky ; abdomen tympanitic, numerous lenticu- 
lar rose-spots ; diarrhoea considerable ; tongue covered with a 
grayish coat, very thick ; trembling of the tongue ; difficulty of 
speech; no headache; cough frequent, without expectoration; 
in the whole extent of the chest, an abundant rale presenting a 
mixture of the sibilant and mucous rales; no absolute matile; 
sonorousness is only moderate in all the chest, posteriorly ; want 
of sleep ; agitated during the night. Ext. cinchona 7-J grains, 4 
scarrified cups on the chest. 

Oct. 18th. Eestlessness during the night — 104 pnlsations ; 
skin hot and dry ; tongue trembling; abdomen tympanitic; gar- 
gouillement in the right iliac fossa ; violet color of the integu- 
ment; troubled respiration; conjunctiva injected; same state 
of the chest on auscultation and percussion. Julep, with cxt. 
cinchona 30 grains ; 30 dry-cups on the chest ; bath in the ward ; 
beef-tea twice. 

Oct. 19th. The cups have considerably relieved him — they 
have left on the chest spots of deep red color, with no trace of 
vesication ; tongue trembling, still covered with a thick coat, 
but not completely dry ; nares dusky ; diarrhoea abundant, in- 
voluntary ; agitation, no sleep ; the cough is less, rales a little 
less abundant. Julep, cinchona 10 dry cups. 

Oct. 20th. 108 pulsations; skin cool ; desires to eat; dissemi- 
nated rales heard in the chest ; cyanosis of the face is less intense. 
Julep cinchona, 10 dry -cups on the chest. 

Oct. 21st. Does well ; has slept during the night ; wants to 
eat; tongue clean ; thorax is sensibly relieved ; rales rarer; less 
mucus. 30 dry cups on inferior extremities. 

Oct. 22nd. Same state. 80 dry -cups on inferior extremities; 
soup four times. 

Oct. 23rd. Color of the integument almost normal ; abdomen 
soft, indolent ; chest almost freed; diarrhoea still involuntary; 
has appetite. Soup four times. 

Oct. 24th. Amelioration increasing; tongue clean; respira- 
tion normal in the whole extent of the chest; has become more 
sonorous ; diarrhoea still involuntary ; has appetite. Injections 
of starch and laudanum ; soup four times. 



184 Typhoid Fever : the Thoracic Form — its Treatment. [March, 

Nov. 1st. Appetite strong; 80 pulsations, small; skin cool; 
sleeps well; tongue moist; still a little diarrhoea in bed; some 
cough, but without rales perceptible to the ear. The state of 
the intestines becomes gradually modified, and the patient quits 
the hospital about twelve days after, cured. 

In this patient, as has been seen, the relief was prompt, espe* 
cially at the moment when the cups were applied in great num- 
bers (18th October). 

The employment of this means has not, however, appeared to 
have any effect upon the intestinal phenomena, which continued 
many days after the favorable termination of the thoracic symp- 
toms. 

[The history of the four following cases, would occupy more 
space than is necessary to prove the success of this mode of 
treatment. I therefore abridge the account of the author, noting 
only those complications which might influence the practitioner 
in deciding on its employment, and perhaps prevent it, if he had 
not the experience of others to support him. — Translator,] 

Observation III. — Typhoid Fever — "d forme Thoracique ;" 
employment of dry -cups to the number of 460. Cure. 

Jan. 31st, 1857. Mary Poussot, domestic. The answers of 
the patient are short, announcing an intelligence, either natural- 
ly weak, or enfeebled by the disease ; sick fifteen days ; chills, 
pains in back and limbs, diarrhoea, want of appetite, great thirst; 
cough intense, without expectoration. These symptoms have 
existed from the commencement. 

Feb. 1st. Actual state, decubitus dorsal ; extreme debility ; 
complete immobility — rising impossible, even to take medicines ; 
face bloated; eyes dull and half closed ; tongue dry, rough, of 
a dirty gray in the middle, bright red at the point, lanceolated ; 
lips and gums sooty ; upper teeth black ; mouth bitter ; tympani- 
tic; gargouillements abundant; five or six stools a day ; pulse 
112, small, contracted, regular ; skin hot ; respiration painful ; 
humid rales in whole extent of the chest ; cough frequent and 
fatiguing; no expectoration; diminution of sonorousness, but 
not real matite ; sensation of heat general ; almost complete 
deafness; no headache ; continual somnolence ; tranquil deliri- 
um ; very numerous spots on the abdomen and the whole of the 
chest. 22 grs. ipecac, in three doses, 60 dry-cups on the inferior 
extremities, 30 grs. ext. cinchona. 

Feb. 2nd. A little better ; is less oppressed ; cough trouble- 
gome; less delirium; less somnolence; less diarrhoea; pulse 112. 
Eales about the same ; face less bloated. Extract cinchona, 30 
grs.; 80 cups on inferior extremities — 40, morning and evening. 



1858.] Typhoid Fever: the Thoracic Form— its Treatment 185 

Injection of 12 gtt. laudanum, and 5 grs. musk ; sweetened gum 
water. 

The cups of yesterday have left large eccbyrnoses upon the 
thighs of the form of the glasses used. 

Feb. 3rd. A little coma ; sleep agitated ; respiration easier ; 
cough less fatiguing and loose; the rales have diminished nota- 
bly; expectoration mucous, but not abundant; pulse 96; skin 
hot; some tinnitus aurium; giddiness. Same prescription ; 80 
cups in two applications; 18 grs. ipecac. 

Feb. 4th. In about the same condition; rales "a grosses 
bulles," throughout the chest ; pulse 92 ; skin less hot. Same 
prescription ; 80 cups ; ipecac. 

Feb. 5th. The patient is sensibly better ; pulse 8-4 ; skin less 
hot; deafness decreased; rales diminishing; oppression sensibly 
ameliorated j coma less ; delirium hardly appreciable ; 80 cups 1 
beef- tea twice, soup twice. Same prescription. 

Feb. 6th. Oppression hardly exists ; general improvement ; 
tongue about the same ; pulse 80 to 84 ; skin without great heat ; 
80 cups. Same injection, same prescription. 

Feb. 7th. Eespiration free; few rales; no cough ; no expec- 
toration; general state satisfactory; pulse 72 to 80; intellectual 
state much better. Omit the cups, continue rest of prescription. 

Feb. 8th, 9th and 10th. General improvement ; continue 
prescription and diet. 

Until the 19th, when she left the hospital, there was the same 
improvement, with the exception of pain in the right shoulder, 
on the loth, which was speedily dissipated by the use of a small 
blister. 

Observation TV. Typhoid Fever ; vomitives; application of 
530 dry-cups on the inferior extremities. 

Feb. 19th, 1857. Elizabeth Pausser, aged 22 years, a domes- 
tic — has resided in Paris six months — was confined two months 
since ; has never been perfectly well since, on account of too 
severe work, 

Feb. 20th. Actual state. — Extreme prostration ; complete 
immobility : gums are brown, covered with sordes to the teeth J 
tongue dry, brown in the centre, red at borders and point ; 
mouth dry ; deglutition easy; no nausea, no pain in the abdo- 
men; four liquid stools, yellow, sometimes involuntary; urine 
scanty, difficult and painful to emit; complete inappetence; 
thirst great ; sonorous rales throughout the chest * cough fre- 
quent; expectoration mucous and tolerably thick: dyspnoea; 
pulse 112, small ; skin hot and dry ; severe headache, eyes half 
closed; complete deafness; spots on the abdomen pretty numer- 
ous. Sweetened gum water, two glasses of seidlitz water in the 
morning, 15 grs. ext. cinchona in the evening; beef- tea 4 times. 



186 Typhoid Fever : the Thoracic Form — its Treatment. [March, 

Feb. 21st; Pulse 112 ; skin hot and dry ; tongue very dirty ; 
little diarrhoea; thoracic phenomena the same, without any 
more intensity. On account of the state of the tongue, tart, an- 
timony gr. |, 15 grs. ext. cinchona, for the evening. 

Feb. 22nd. Emetic acted three times; little diarrhoea; pulse 
112, small, compressible; skin less hot. Same prescription, less 
of tart, antimony. 

_ Feb. 23rd. Inspiration much more embarrassed. On both 
sides, and at the summit of the chest sibilant rales are heard, 
mucous rales very abundant everywhere else ; otherwise, same 
general state. 30 dry cups on inferior extremities, rest of pre- 
scription ut supra. 

Feb. 24th. She says that the cups have given her great re- 
lief, and asks for them again ; in fact, the chest dilates better, 
and respiration is less painful. The pulse is 116, comrpessible ; 
skin hot ; tongue more humid ; epistaxis for the first time. 30 
dry cups, ext. cinchona 15 grs., beef-tea 4 times. 

Feb. 25th. A little delirium; pulse 112; sacral region red; 
state of chest nearly the same. 50 cups, injection of 5 grs. musk, 
3 iss* laudanum. 

Feb. 26th. Less oppression ; the rales and dyspnoea are less 
marked ; delirium more calm. 50 cups. 

Feb. 27th to March 7th. 50 cups, 40, 40, 40, 30, 30, 30, 30, 
30. Other treatment consisted of ipecac, cinchona, wine, beef- 
tea, etc., according to indication. On the 28th, she left the 
hospital perfectly cured. 

Obsekvation V. August 14th, 1857. Eliza Eoger, aged 
22 years — sick more than a month — miscarried ten days since, 
at six and a half months ; the lochia flows still. Actual state, 
very much like that of Observation IV. 2 glasses seidlitz water, 
100 dry cups (50 morning and evening), beef-tea and soup. 
The treatment of this case, up to the 21st, was that of the cases 
mentioned above, consisting of cinchona, laudanum, enemas, 
soups, etc.; 50 dry cups morning and evening, daily. The im- 
provement of the patient was marked — cough lessening; rales 
diminishing ; tongue becoming cleaner ; sleep good ; diarrhoea 
less; pulse less frequent. On the 21st, the cups were discontin- 
ued, diarrhoea became abundant, but the chest seemed to be 
doing well. Laudanum enema. 

[Although the cups were no more used in this case, still the 

* The original reads 6 grammes, equal to 3iss of our measurement, evidently 
an error. From what I have seen of the practice of French physicians, I "would 
hardly believe that the amount given was one-fourth of that quantity. They 
give opium in much smaller quantities than we do. — Translator. 



1858.] Typhoid Fever: the Thoracic Form — its Treatment. 187 

disease having assumed a new phase, demanding a different 
course of treatment, and the treatment of this particular patient 
illustrating that of the French, generally, I will give the author's 
account in full ; and as it was successful in this instance, it may 
be of practical benefit to some of the readers of the Journal. Tr.] 

Aug. 22nd. The cough became again very painful ; rales 
are heard anew throughout the chest ; the sputa are bronchial 
with some filaments of brownish blood ; sleep is impossible, on 
account of the frequency of stools. Gooseberry syrup ; continue 
enema (laudanum gtt. xij.); beef-tea, 4 times. 

Aug. 23rd. Diarrhoea still more frequent. Add to prescrip- 
tion a potion, with 4 gtt. laudanum. 

Aug. 24th. At night, on the 22nd and 23rd, she had some 
vomiting, of which no mention was made at the visit of yester- 
day. Yesterday evening, the vomiting recommenced, accom- 
panied by a liquid diarrhoea, very abundant, white, persisting ; 
dejected aspect ; eyes sunken, surrounded by a bluish circle ; 
indifference to surrounding objects ; immobility; visage wasted; 
speech feeble, slow — complains of suffocating; pulse 100, hardly 
perceptible ; blue voluminous veins are seen upon the chest ; 
skin cold; pulsations of the heart barely perceptible. It is im- 
possible to know if the patient urinates, the stools being invo- 
luntary, may be mixed with urine. The potion of laudanum 
prescribed yesterday was vomited on the spot ; in the evening, 
the interne of the ward, prescribed ice; gum julep 3v, with 
rum 3 ij ; diet. 

Aug. 25th. She vomited but once during the day of the 
24th, but in the evening, the vomiting recommenced and lasted 
all night. She has had but one stool, which is yellow ; she ap- 
pears a little better. Her pulse is a little increased in frequency 
(112) ; the skin has resumed its heat ; face less pale, but the eyes 
are as much sunken. Same prescription. 

Aug. 26th. Eeaction is fully established ; pulse 108 ; skin 
hot ; face red ; eyes sunk. Still some vomiting, but no diar- 
rhoea. Urinated yesterday. Ice ; beef-tea twice. 

Aug. 27th. In the night, vomited considerable quantity of 
bile, in which there floated numerous white clots; pulse 108, 
small, dicrotic; skin hot; face red; eyes less sunken ; extreme 
debility; three diarrhceal stools; tongue moist, lighty white; no 
headache ; great thirst. 2 large enemas, with 12 gtt. laudanum 
in each ; ice ; soup twice. 

Aug. 28th. Pulse 108; skin very hot; vomiting continues; 
diarrhoea. Continue enema potion with rum 5iij ; ice; diet. 

Aug. 29th. She has again vomited this morning, a green 
liquid ; tongue a little swollen, yellowish gray; pressure upon 
8* 



188 Typhoid Fever : the Thoracic Form — its Treatment. [March, 

the right iliac fossa determines pain ; abundant diarrhoea ; urin- 
ates easily; pulse 100, dicrotic; eyes less sunken, visage good. 
The patient says she does not suffer ; aspect better. Continue 
the treatment. 

Aug. 30th. She has vomited a little, but her visage has as- 
sumed its normal aspect ; slept all night and without waking; 
mouth bad; diarrhoea; pulse 96, dicrotic. 2 large enemas with 
laudanum 12 gtt.; beef-tea 4 times. 

Aug. 31st. Has not vomited since ; tongue humid, hardly 
white ; thirst ; a little appetite ; no diarrhoea ; sleep good. Laud- 
anum enema; half portion (hospital diet). 

September 1st. No more vomiting ; no stools for two days ; 
aspect good ; face rose color ; eyes not sunken ; pule 96, scarce- 
ly dicrotic ; tongue humid ; sleep good ; ate with pleasure. Demi- 
portion. 

Sept. 2nd. Continues better. One portion. 

Sept. 5th. Doing very well ; tongue rose-color, humid ; ap- 
petite ; little thirst ; no diarrhoea; pulse 68 ; skin cool. 1 portion. 

On the 7th, she ate some unripe grapes, followed by diarrhoea 
* on the 8th : that evening vomited a little, also at night. Pulse 
96 ; skin hot. 2 enemas, laudanum gtt. xij, in each. 

Sept. 10th. This new indisposition was followed by no re- 
sults. Left the hospital well. 

Here again is seen the modification obtained by the use of the 
dry-cups, and the return of the epi-phenomena at the moment 
they were suspended ; the intercurrent choleraic symptoms ren- 
dered a new employment of this means useless. 

In the observation about to follow, the commencement of 
which did not pass under my eyes, I will call attention to the 
nature of the expectoration, which was at first composed of 
sputa of a yellowish color, thick, rounded, nummular, quite an- 
alogous to those observed towards the end of the measles, and 
which presented afterwards some sanguinolent striae. 

The generalization of the rales, their seat the summit, the 
lively heat of the skin, the small number and doubtful appear- 
ance of the spots — all in a woman, blonde, chlorotic — could give 
rise to doubts, at first sight, upon the diagnosis, and lead to the 
impression that we had to do with an acute phthisis. The in- 
testinal phenomena, and the march of the disease, assisted us in 
avoiding that error. 

Observation YI. — Typhoid Fever, " d forme Abdominale in 
its debut; thoracic phenomena towards the twenty -second day. 200 
cups ; ext. cinchona. Cure. 

Eliza Legarois, age 15 years, domestic ; always of good health ; 
not yet menstruated — has lived in Paris only one month. Two 
or three days after her arrival at Paris, she was taken with a 



1858.] Typhoid Fever : the Thoracic Form — its Treatment. 189 

bad headache, which persisted, eblouissernents, (to which she is 
subject); cough, with oppression ; diarrhoea not abundant ; com- 
plexion dull and white, hair light, mucous membranes pale, 
continued souffle in the vessels of the neck. 

On her entrance, Sept. 23rd, about the eighth or tenth day of 
the disease, a typhoid fever "a forme abdominale," with symp- 
toms not grave, was diagnosed. 

During the first days of October, the cough augmented in 
frequency and intensity ; she became more oppressed. 

Oct. 11th. Besides the abdominal phenomena slightly mark- 
ed, I found, in the chest, numerous rales, offering towards the 
two snmmits, characters of the sibilant, and towards the middle, 
as far as the base, a mucous stamp, especially on the right side. 
Apply 40 dry-cups on inferior extremities; sweetened gum wa- 
ter ; ext. cinchona 1\ grs. 

Condition of the patient Oct. 12th. Coughs as much as dur- 
ing the preceding days, but says she is less oppressed since the 
cups were applied, and expectorates more easily. The sputa 
resemble those of a bronchitis at the period of coction ; they are 
yellowish, thick, rounded, much striated with brown blood, 
(proceeding from the fauces,) and in no way analogous to that of 
pneumonia : tongue tolerably humid, glutinous, wide at the 
points, yellowish-gray at base and middle ; mouth bad ; no ap- 
petite; considerable thirst; a little diarrhoea; two to five stools ; 
gargouillement pretty abundant in right iliac fossa ; no pain on 
pressure of the abdomen ; no well-marked rose-spots ; no sleep ; 
pulse 96, skin a little hot. Percussion indicates nothing very 
abnormal in the chest, which, however, does not resound well ; 
without real matite, especially on the right side. Auscultation 
reveals mucous and sonorous rales in all the chest — thej^ are sibi- 
lant towards the two summits, and mucous at the base and 
middle parts, posteriorly, particularly on the right side. Ext. 
cinchona, grs. xxx.; pil. opium, gr. §; coffee, f^iv. ; 40 dry- 
cups. 

Oct. loth. Coughs as much — is also oppressed; does not 
sleep; same sputa, still sanguinolent, abundant. Same pre- 
scription. 

Oct. 14th. Oppression a little less; rales still abundant, al- 
though less numerous ; tongue cleaner ; pulse less frequent (88), 
skin but little hot. 40 cups. 

Oct. loth. Still much oppressed ; sonorous rales throughout 
the chest; intermixed with less of the mucus ; little sleep, pulse 
at 88, skin less warm. 40 cups. 

Oct. 16th. Says she is much better ; she respires more easily ; 
the rales have much diminished, and the sonorous rales are 
rarer; sonorous rale is better marked; cough less painful ; ex- 
pectoration easy ; the sputa are less thick, less yellow, but little 



190 Tyhhoid Fever : the Thoracic Form — its Treatment. [March, 

striated; tongue moist, wide, whitish; no thirst; a little appe- 
tite ; pulse 68, regular ; skin cool. Omit the cups ; two eggs, 
and a little bread ; ext. cinchona 30 grs. ; sweetened gum water 
for drink. 

Oct. 17th. Pulse 48, regular ; skin cool. It is with difficul- 
ty that one hears a few rales in the chest. No diarrhoea ; ex- 
pression much better and more gay : on the whole, she does well. 
Bordeaux wine, § iiiss., cinchona 30 grs., one portion. 

Oct. 18th. Pulse 60 ; skin cool : does well. 19th. The pa- 
tient feels well, has a good appetite, sleeps well ; only she is 
feeble, and when she desires to rise and walk she falls — not that 
she has attacks of giddiness, but her legs bend under the weight 
of her body. 

This condition still improves ; the respiration to day (22nd 
October) is everywhere pure, without mixture of rales ; no ex- 
pectoration : the diarrhoea has disappeared ; pulse from 60 to 64, 
it assumes a little consistence; appetite is excellent; debility 
and palor are the only symptoms which persist. 

I could add to these facts, many others, which would only be 
a repetition. I hope those which precede will appear conclu- 
sive in favor of the means which I propose — which, I repeat, 
has given most satisfactory results to my friend, Dr. H. Bourdon, 
upon the patients observed by him at the "HopitalLaribosiere." 
I will insist upon the complete harmlessness of this mode of 
treatment ; never have I observed any local disorder follow the 
application of dry cups, and never has this derivation, although 
very energetic, determined any trouble in the economy, proba- 
bly because it is, so to say, gradually effected. This harmless- 
ness is, then, one motive the more, why we should not hesitate 
before the employment of this means. 

It has been remarked, also, in some of these observations, 
(obs. 2, 3, 4,) that somnolence, tranquil delirium and deafness, 
have seemed happily modified by the use of this means. I have 
seen, in some other cases, the application of dry-cups in great 
numbers, calm the tranquil delirium and dissipate promptly 
both somnolence and coma, notably, in a little patient of 15 
years, observed in October, 1855, at the "Hopital Beaujon." 
In these last cases, the cerebral phenomena were predominant, 
and nothing very well marked was determined on the side of 
the lungs. The utility of this powerful derivative in comatose 
forms of the disease, appears to me, more than probable; but I 
have not, so far, studied the fact in a sufficiently rigorous man- 
ner to form a precise opinion on the subject. As for the ataxic 
forms, with violent delirium, in three cases where I attempted to 
employ this method, it gave me no result, and the opiate pre- 
parations, in doses sufficiently strong, united with musk, appear 
to me to be much preferable. — [Archives Generates. 



1858.] Report on the Epidemic Diseases of Georgia. 191 

Report upon the Topography and Epidemic Diseases of the State of 
Georgia. By John F. Posey, M. D., of Savannah, Ga. 

[Concluded from p. 114, Feb. No.] 

Diseases, &c. 

The diseases of the eastern part of the first division or tertiary- 
formation of Georgia are thus treated of by Dr. P. M. Kollock, 
of Savannah, beginning with the Sea Islands : — 

11 The inhabitants enjoy very great immunity from the diseases 
of the opposite main. And such as have few or no brackish 
ponds or lagoons, are more healthy than such as contain a greater 
number. 

" In very wet seasons, the different forms of miasmatic and 
bilious fevers prevail to a considerable extent, but they are ex- 
empt from every species of malignant and fatal epidemics. I 
have never known cholera asphyxia to occur on any of the outer 
islands. In winter, sporadic cases of pneumonia are occasional- 
ly met with, together with ordinary catarrhal and pleuritic affec- 
tions. 

M The main opposite the Sea Islands is decidedly sickly, and in 
fested by the various forms oi miasmatic disease. 

"In winter and spring, epidemic pneumonia, of typhoid type, 
is not unfrequent, particularly on the rivers and swamps. In 
summer and fall, the various forms of bilious fever, sometimes 
congestive, and occasionally exhibiting typhoid symptoms, pre- 
vail. 

"Passing further inland to the region of sandhills and long- 
leaf pines, the inhabitants enjoy a very large share of health, and 
when the possessors of the comforts of life, as regards shelter, food y 
and raiment, exhibit an embonpoint, a ruddiness of complexion, and 
contented, happy expression of countenance, seldom surpassed 
in any climate. As a general rule, they are strangers to epidem- 
ics of all kinds. 

" In winter and spring, cases of pneumonia are met with, and 
in summer, particularly in seasons prolific of fruit, there may be 
dysentery ; it is rare for severe cases of fever to occur in this 
section. 

"The winter of 1852 was the coldest that has been known for 
many years in this district. Two snow storms occurred at Sa- 
vannah, but very little rain. There was no great amount of dis- 
ease — a few cases of pneumonia occurred in my own practice — 
and I observed a very strong tendency to the formation of whit- 
lows, resulting from slight injuries to the hands. 

"Towards August, cases of fever began to multiply in the city 
of Savannah and its vicinity, and between that period and the 
month of November, very few of the laboring population escaped. 



I _ Report cm the Epidemic Diseases of Georgia. [March, 

-Daring the month ac- 

: : v .- ; -. - : : _ . : iz'n =r. :=:■". ;jte :; v. :; .=-. =: :.v.^:-. -vere re- 
ported; the number increased as the season advanced. 
greatest number occurred as the season advanced to the mouth 
of October, when h proved fatal in almost every instan: 

low fever was bat little known until after the war of 
It was not until the winter of 1816 that for^ 
began to resort to Savannah, and the next summer the harbor 
was crowded ; no care was taken to time the arrivals to the 
h ea l thy months, and the seamen were strar, _ unaccli- 

mated. 

In the man - -gust, the veflow Ae out It 

was c onfin e d to the seamen, and continued until the shipping 
departed; there were not many cases. During the folio 
ere were few arrivals, and all had left port b^ 
the wwurr had fairly set in, and there was bat little sickne 

In the year 1819 many ships arrived br at many 

sliangeis, totally unused to the climate and unacquainted with 
the diseases to which they were exposed. Early in the autumn, 
the yellow fever commenced its ravages, and in less than a month 
the whole number of passengers who had been brough 
ship had fallen victims ; the disease A until 

an: ~ \\ r.'rr-/: ~r.*. --. *: strsr.rer^ 

.he beginning of the year K part of the city was 

burned down, and the population was consequently crowded into 
the narrow Emits left by the fire. The fi the most 

part left in a state of total neglect, and ma ered 

sinks and vaults remained open, exposed to the weather until 
they were filled up by the sand washed into them by the rain, 
which was more than usually copious in the latter part of the sea- 
son. The excavations made forthefoun: f new build- 
ings were highly offensive, particularly duri- 

In the latter part of the summer, the 
increased to a frightful extent, but its ravages 
among the unacclimated, few natives or old resident The 

disease continued until late in the win: 

In 1821 the yellow fever began as in the year before, and now 
attacked the natives and old residents, more of whom died than 
the year befc 

The citizens were now thoroughly alarmed ; a board of health 
was organized, and a system of visitation (A the yards and build- 
ings was put in operation; a new sea lent was 
made, and the city was thoroughly cleansed, so that the Cathar- 
tes aurea and C. atratus, commonly known as Turkey buzzards, 
winch were as tame as barnyard fowls, at :tive 
scavengers before, became wikL The yellow fever also disap- 
peared, and for five years was not seen. The dread of 'tis v 



1858.] Report on the Epidemic Diseases of Georgia. 193 

tion seemed to have been forgotten, the members of the Board of 
Health soon became tired of their "useless*' labors, and ceased 
to attend to their duties. An officer was appointed to inspect 
the lots, &c. but his visits soon became odious to those who most 
needed them, and the city became very exactly in the condition, 
as to cleanliness, that it was in before the beginning of the three 
years of fever. The Cathaites aur. and atr. returned, and in the 
early part of the summer of 1527 they were seen in the most 
populous part of the city fighting for offal in the street. Xot Ions 
after this, the yellow fever made its appearance and carried off 
seven of the most prominent citizens, being all old residents, in 
rapid succession. This opened the eyes of the people to the ne- 
cessity of a more constant attention to sanitary measures: the 
city was again thoroughly cleansed, the buzzards again took to 
the woods, and have never returned. 

The yellow fever has not since been epidemic until the vear 
1S54. when the city being crowded with Foreigners, mostly Irish 
laborers, it broke out again with such mortality as to produce 
general consternation; however, but few of the acclimated were 
severely attacked. 

The epidemic spread more widely in the State than it ever had 
before. 

In the autumn of 1834, the epidemic cholera commenced on 
some plantations twelve or fourteen miles above Savannah on the 
river, and gradually approached the city, where it continued for 
nearly two months, when it ceased its ravages verv suddenlv ; 
negroes were the principal sufferers, and upon its appearance" a 
few years afterwards, it was confined almost entirelv to them. 

Dr. O. P. Bealer, of Effingham County, in a communication 
to Dr. Kollock. in 1853. says : " The prevalent disease of the last 
year, 1852, was typhoid fever, in the majority of cases, the result 
of neglected bilious fever ; it was remarkably fatal ; the deaths 
in this county the last year numbered more that those of anv one 
year, as far back as the oldest citizens can recollect, and* thev 
were principally from typhoid fever. 

Dr. T. R. Dunham says, that "the prevailing diseases of Cam- 
den County in winter and spring, are typhoid pneumonia and in- 
fluenza. These yield during the summer and fall to diarrhoea, re- 
mittent and intermittent fevers, accompanied with the most violent 
headaches, and great irritability of stomach." 

Dr. T. S. Hopkins, of Waynesville, writing of the diseases of 
the low lands in Glynn and Camden Counties, in the neighborhood 
of the Great Buffalo Swamp (which section, he savs. is healthy 
in very wet or very dry seasons.) in the year 1852. says: "The 
past season has been extremely wet, and I have onlv to "report, for 
the spring months, a mild form of influenza., and for the fall, quo- 
tidian and tertian intermittents." 



194 Report on the Epidemic Diseases of Georgia. [March, 

Dr. H. Briggs, of Troupville, speaking of Lowndes County, 
says: "The climate disease which manifests itself more or less, 
during some part of every year, is the remittent or intermittent 
malarial fever, usually of a mild form, but with occasional cases 
of malignant intermittent, congestive, alged, and other varieties 
of pernicious fever. 

" Hooping-cough, mumps and varicella have repeatedly prevail- 
ed in all this region as epidemics. 

" Scarlatina prevailed co-extensive with the limits of the county 
during the years 1838 and 1839. It has appeared twice since, in 
1844 and 1855, but could scarcely be considered an epidemic, 
either of the two last times. 

"Abscess, in the form of whitlow, furunculus, anthrax, and 
deep-seated abscess, has sometimes appeared as an epidemic, more 
especially during the summer and fall of 1854, continuing several 
months, the ordinary climate fever disappearing altogether during 
the time. 

"Dysentery appeared as the prevailing disease in the autumn 
of 1843, from which time till the spring of 1853, there were only 
a few sporadic cases. It has prevailed more or less at all seasons, 
and in all parts of the county from that date up to the present. In 
some neighborhoods the accompanying fever is of typhoid type, 
in others most decidedly inflammatory. 

" Rubeola made its appearance in June, 1856, for the first time 
since 1837. The disease was of a grave character, often attended 
with low form of fever, and dysenteric symptoms, often succeeded 
by a most obstinate diarrhoea, oedematous swellings of the lower 
limbs — a tendency to passive hemorrhages, and sometimes ulcer- 
ations and sloughing of the integument. 

" Influenza, or grippe, often becomes epidemic. It seems to 
act as a predisposing cause of bronchitis, pneumonia, pleurisy and 
catarrhal ophthalmia. Sometimes a patient complains of violent 
pain in the head for a few hours without any signs of pneumonic 
inflammation, quickly followed by prostration, coma, difficult res- 
piration from mucus accumulating in the bronchial tubes ; death 
soon ensues. 

" A continued fever prevailed in the western part of the county 
in the latter part of the year 1839, and first half of the succeeding 
year. Again in the southeastern part of the county, through all 
the winter and spring from November, 1846, to April or May, 
1847. A malignant fever and highly contagious typhoid fever 
have prevailed in some section of the county more or less every 
year since 1850; a half dozen or more cases in one family or 
neighborhood, then appear somewhere else. The county has 
not been entirely clear of cases of that variety of fever, but very 
few months in all the last six years. 

" In the spring and summer it very much resembles ordinary 



1858.] Report on the Epidemic Diseases of Georgia. 195 

remittent for a few days at first. In the colder part of the year 
it is usually without any regular remission, a straightout continued 
fever from the beginning. 

" Puerperal fever is sometimes for a few months much more 
prevalent than at others ; I do not, however, believe it has occur- 
red as a true epidemic disease. 

" The same is true as regards jaundice, uterine hemorrhage 
and many other non-febrile diseases. 

" Dirt eaters and anaemic patients are always extant." 

Dr. G. F. Cooper, of Houston County, in 1853, thus gives the 
prevalent diseases of that county., which may be taken as the 
sample of all the upper part of the first or tertiary division. " Ru- 
beola, diarrhoea, dysentery, and idiopathic fevers," he says, "con- 
stitute the list of diseases which have been treated during the last 
year. 

During the months of April and May, we had an extensive 
epidemic rubeola, so called, and in some parts of our county it 
was attended with a fearful mortality. This was especially the 
case where a typhoid type obtained. Many of the cases which 
came under our observation did not possess the usual character- 
istics of rubeola, and even those in which the eruption conformed 
nearest to the genuine form of the disease, desquamation did not 
follow. It appeared to me to be a blending, in many cases, of 
rubeola and roseola. The rubeolous eruption was evolved upon 
a roseolous base, the latter, I believe, appearing invariably first, 
followed by the papulous eruption of measles. The eruption 
usually appeared on the third or fourth day, and was shorter Jived 
than in genuine measles, particularly in those cases where roseola 
prevailed, and was observed to be wanting in that crescentic ar- 
rangement laid down by authors. It also attacked a number 
who were known to have had rubeola previously. No age, se% 
or race was exempt. In those cases where roseola appeared, the 
attack was not accompanied by any catarrhal symptoms. 

" In all cases there was an unusual proclivity to diarrhoea ; this 
appeared to be independent of the eruption, for in many cases 
where it was standing out in full crop, diarrhoea would be persist- 
ent, with griping pains and vomiting, and not unfrequently, the 
former were exceedingly severe. 

"It was also remarked that, after the entire subsidence of the 
eruption, the diarrhoea would continue for days. 

" During the prevalence of this epidemic, there was a high 
range of temperature, the thermometer not unfrequently rising 
above 90°. Rains were frequent; it was almost continually 
cloudy, with a high dew-point. 

" As is usual in wet seasons, intermittent and remittent fevers 
prevailed to a great extent, but we had less typhoid fever than 
the previous year." 

N. 8. — VOL. XIV. NO. III. 9 



196 Report on ike Epidemic Diseases of Georgia. [March, 

The diseases of the lower part of the second or primitive geolo- 
gical division of the State vary considerably, according as the 
locality approaches the lower or upper limits of the old settlements 
below the mountains. 

Dr. Wynn, in a letter to Dr. G. F. Cooper, says : " in Monroe 
County they are free from the usually called 'local causes' of 
disease, and from their usual consequences, intermittent and bil- 
ious remittent fevers, and they have been very rare for several 
years. 

"In the early spring and winter, we have a little pneumonia, 
catarrhal influenza, &c. In summer, enteric affections prevail, 
diarrhoea, dysentery, and cholera morbus. 

"Our fevers of summer are those that have received among us 
the name of typhoid, though I must say I have seen none that I 
thought approximated in its symptoms the specific typhoid fever 
of the books. But for all the cases that I have seen, I like better 
the title of nervous, for they all have wanted the enteric lesion., 
the large spleen, the eruption, &c. 

" In fact, they have seemed to me entitled to be considered con- 
gestive fever, with cephalic tendency, 

"Dr. Hood, of Harris County, says: 'In the spring of 1851, 
typhoid diseases became epidemic, and were the prevailing dis- 
eases until May, 1852, when we were visited with another and 
more fatal form of disease, though I considered it a modification 
of typhoid fever." 

" Another class, or modification of the same disease, prevailed 
at the same time, and with fearful fatality. It presented all the 
features of the foregoing, attended with frequent bloody sanious 
stools, recurring at regular intervals in many cases, in spite of all 
treatment; opium, morphine, tannin, acetate of lead, anodyne 
enemata, &c, &c, and continuing week after week, to death or 
recovery. The small bowels were evidently the seat of the 
disease ; no griping or tenderness in the region of the colon or 
rectum." 

Dr. Knott, of Griffin, Spalding County, communicating to Dr. 
Cooper, in 1853, says: "The most prevalent diseases among us 
in winter, are pneumonia, typhoid pneumonia, pleuro-pneumonia, 
bronchitis, inflammatory fever, rheumatism, neuralgia, &c. In 
spring, diarrhoea, especially among children, dysentery, among all 
classes, ages and sexes. In summer and autumn, occasional cases 
of bilious fever, with a marked tendency from the first, to run into 
the typhoid form. The most remarkable feature of pneumonia, 
is its complication with the typhoid form of fever, and in some, 
cases, not characterized by marked remissions or exacerbations. 
In all the cases of diarrhoea and dysentery, the bilious diathesis 
was present, consequently I directed my remedies to that function. 

" In the treatment of typhoid fever, as well as pneumonia of 



1858.] Report on the Epidemic Diseases of Georgia. 197 

like character, my reliance was upon mercurials, with a view to 
their alterative effect, and antimonials, as a sedative, combined 
with opium, aided by mild saline cathartics, and as valuable aux- 
ilaries, counter-irritants." 

In approaching the mountainous part of the second division, 
it is found that the diseases are more inflammatory in type, seem- 
ing to be more the effect of the great and sudden changes in the 
temperature and moisture, than of any local causes, especially in 
the winter and spring months, but in some places spring inter- 
mittents, attributed to malaria, are frequent. 

In the summer months, bilious remittents and intermittents are 
occasionally met with, and in wet seasons, diarrhoea, cholera mor- 
bus, and other disturbances of the digestive function, are not un- 
common, especially during the greatest heat. 

In the fall of the year, bilious fevers put on a more malignant 
form, most commonly with someone symptom, or some complica- 
tion seeming to take the lead, and to give character to the disease 
in one year, and some other peculiarity in the next : thus, if in 
the commencement of a sickly season, we see a case of fever be- 
ginning with the usual feeling of lassitude, uneasiness, pain in the 
head and back, but with less flush on the skin, and the pulse not 
so full and bounding as in other cases, with slow deep breathing, 
and a torpid, careless state of mind, with constricted skin — "goose- 
flesh" — on the application of cold air or water to any part of the 
surface, indicating an irregular circulation, with determination 
to the deep seated bloodvessels — we have a case of congestive 
fever. And we are exceedingly apt to find it followed shortly by 
other cases very much like it. In fact, for some unknown cause, 
every disease of whatever kind, even if caused by mechanical 
injury, will show more or less proclivity to this same congestion. 

Again, if in the beginning of the fall fever season, we see a 
case of urticaria running into fever, with great heat of the surface, 
anxiety, oppressed breathing, restlessness, and violent pain in the 
head and back, we have a case of " rash-fever," which will, most 
probably, tax our skill and industry to the utmost: and will doubt- 
lessly be followed by like cases during all the remaining season. 

Thus we have once in a while, an epidemic fever of one name, 
and then of another, as one symptom or another, or one complica- 
tion or another may happen to prevail. 

Scarlatina, rubeola, varicella, pertussis, parotitis, erysipelas, 
dysentery, and some other diseases of minor importance have 
prevailed as epidemics at uncertain intervals of time, in the whole 
of the primitive division of the State. 

We now come to the diseases of the third division of the State, 
the transition, or blue limestone region ; the last part of the 
State settled. 

I am. indebted to Dr. Robert C. Word, formerly of Cassville, 



298 Report on the Epidemic Diseases of Georgia. [March, 

Cass County, but now of Rome, Floyd County, for all that I can 
say on this subject. 

Dr. Word prefaces his account of the diseases of this country 
by a notice of the domestic habits of the people. 

" Much of the disease," says he, " peculiar to the country is un- 
questionably due to a disregard of the laws of health. Imprudent 
exposure to the multifarious changes of climate, is the most fre- 
quent exciting cause of disease in the colder seasons. Though, of 
late years, it may be said that a majority of the inhabitants are 
well clothed, yet their houses are generally too open to furnish 
adequate protection from the chilling moisture of the winter sea- 
son. Defective ventilation in cities is, perhaps, not more injuri- 
ous to health than excessive ventilation in the country. Much of 
disease, also, may be attributed to cold, wet feet, consequent upon 
the muddy nature of the soil, for which the country is proverbial, 
and to which long custom has rendered the people careless and 
indifferent. 

" As would be inferred, from the varying circumstances which 
we have mentioned, different diseases prevail during different 
seasons of the year, and furnish to the practitioner a more diver- 
sified experience than is found in some other localities. Catarr- 
hal lever, rheumatism, pleurisy, pneumonia, and kindred phleg- 
masia?, are common in winter and the early part of spring. Ty- 
phoid fever, a few years since, was only observed in winter, and 
is still most generally designated, in popular language, as winter 
fever. More recently, it has occurred also in summer and 
autumn. With the commencement of the heat of summer, a few 
sporadic cases of dysentery and diarrhoea make their appearance, 
becoming gradually more numerous, until they are so generally 
prevalent as to deserve the name of epidemic. Not unfrequently 
having so prevailed for a few weeks in June and July, thy subside 
for a time r to reappear in a more fatal form during the autumn, 
a few cases of remittent and intermittent fever are met with in 
the early part of summer ; they usually increase in number and 
violence as the season advances, and shortly before the return of 
cool weather, occasional examples of the congestive form of this 
disease are observed, rarefy, however, at an earlier period. Not 
unfrequently these febrile attacks make their appearance during 
the suspension which has been remarked in the prevalence of 
bowel affections, and continuing conjointly with them, but attack- 
ing different subjects until the end of the warm weather. 

"The autumn is marked often by the prevalence of influenza, 
of a mild form, which some persons have attributed to the great 
difference between the temperature of the days and nights at this 
period, and others to the constant inhalation of the dust, with 
which the atmosphere is loaded. 

" The almost regular succession of annually prevalent maladies, 



1858.] Report on the Epidemic Diseases of Georgia. 199 

and many others of occasional, but irregular occurrence, together 
with the marked peculiarities impressed upon all in particular 
years, or during particular seasons, by prevailing epidemical or 
atmospherical influences, exact an unusual amount of caution 
and practical tact in diagnosis. 

" A few years after the first settlement of the country, malarious 
diseases were uncommon, inflammatory diseases more frequent 
than at present, the inflammation of higher grade, and vigor- 
ous antiphlogistic treatment better borne, and more successful 
than at present. With the clearing up of the land, exposing a 
larger surface, covered with a rich vegetable mould, and satura- 
ted with the rains of winter, to the action of a summer's sun, 
there has been a marked increase of all the afflictions which 
malaria is supposed to produce, and a very observable modifica- 
tion in the general sanative condition of the population, or in the 
character of many diseases which it is not pretended that malaria 
originates, but over which it appears to extend its mysterious in- 
fluence. Many of the inflammatory attacks, occurring in winter 
in the last few years, have been found to assume the livery of this 
subtile morbific agent, evincing a decided tendency to periodicity, 
and demandimg the administration of quinine. Many others, it 
is true, offer no such peculiarity, but are truely and frankly phleg- 
masise, requiring for their successful treatment free and bold 
employment of the lancet, and all the antiphlogistic expedients so 
familiar to the past generation of physicians. This intermingling 
of symptoms, blending of lights and shadows, is still more com- 
mon in autumn and spring, and more embarrassing, because a 
just diagnosis is often difficult, and a mistake highly dangerous. 
To subject a patient previously enfeebled my miasmatic influence, 
or actually laboring under an irregular form of miasmatic disease, 
though simulating, with astonishing accuracy, an acute inflamma- 
tion, to the debilitating effects of the antiphlogistic treatment is 
not simply unnecessary, but as has been too often sadly demon- 
strated, hazardous or fatal, producing prolonged debility, tedious 
convalescence, or else speedily, or more remotely death. To 
omit to do so, upon the other hand, when an important organ is 
truly the seat of active inflammation, is to expose him to immedi- 
ate peril, or to the doubtful consequences of the pathological chan- 
ges by which that condition is followed. In a more malarious 
region, as well as in districts where the influence of malaria is 
less marked, the nice discrimination so often demanded here is, 
perhaps, less important, but the ability to make it, in this section, 
decides between success and the want of it. 

" Tubercular disease, although it cannot be said to be preva- 
lent amongst us, is by no means unfrequent. Tubercles in the 
lungs are more common than in more southern and less elevated 
regions, where there are fewer alternations in the weather, and 



200 Report on the Epidemic Diseases of Georgia. [March, 

less humidity. Experience has shown that the locality is not a 
good one for consumptive persons, or those who are predisposed 
thereto. Whether originating in the country, or introduced 
from abroad, the disease runs rapidly through its various stages 
to a fatal termination. 

" Typhoid fever, I believe, made its first appearance in this 
part of the State in the winter of 1842, at which time a number 
of cases were seen in the immediate vicinity of Cassville. For 
a few years subsequently, the disease was confined entirely to the 
winter season, and it was not until about the year 1846 that it 
began to occur in the spring and fall. In the years 1846 and 
1847, it prevailed extensively throughout the greater portion of 
Cass County. More than sixty cases came under our observation 
in those two years, and though the fatality was not very great, 
the cases were generally obstinate and tedions, running their 
course in a period of from three to six weeks, with a tendency to 
a favorable termination when unmolested by drastic remedies. 
Most of the fata] cases which occurred we believe to have been 
due to the injudicious use of purgative medicines, usually pre- 
scribed by the patients themselves before consulting a physician. 
Since the period above referred to, the disease has continued to 
prevail, varying in extent and violence at different times, and ex- 
tending its baneful influence to other and milder maladies. Occa- 
sionally it breaks out afresh in different or in the same localities, 
complicated with features and peculiarities not previously obser- 
ved. Many cases present malarial peculiarities, and are marked 
with tertian exacerbations. Others are complicated with pneumo- 
nia or rheumatism. It has been followed by the congestive form 
of the disease, which in a large majority of cases, proved rapidly 
fatal." 

Dr. T. J. Word, of Floyd County, in ]853, said that "typhoid 
fever has prevailed in Floyd as an epidemic for two or three 
years past mostly between the months of October and the begin- 
ning of spring, during which time it has taken the field to the ex- 
clusion of most other diseases, or compelled them to form an 
alliance with it. In the fall, it was occasionally associated with 
remittent fever; in the winter with pneumonia. In the nervous, 
it was sometimes associated with neuralgia, and in the female, 
with hysteria. 

" The cause of its general prevalence for a few years past can 
only be satisfactorily explained by admitting it to be an epidemic. 
Upon no other ground can we explain its appearance in regions 
where not one of the local or endemic causes exist to which its 
production has been ascribed. 

" It occurs in the hilly and broken sections of the country, and 
in families who enjoy all the comforts of life, and are exempt from 
every apparent local cause of disease. Other causes than confin- 



1858.] Report on the Epidemic Diseases of Georgia. 201 

ed or vitiated air. decomposing animal or vegetable matter, or 
standing water, mast be adduced, as it is known to occur in a 
malignant form where none of these causes exist. ' The presence 
of the typhoid principle in the surrounding medium exercises a 
controlling influence over the cause and duration of other diseases/ 
In further confirmation of this view is mentioned the increased 
or altered sensibilitv of the gastro-intestinal canal to the impres- 
sion of cathartics, that part of the economy to which the force 
and violence of tvphoid fever is directed. ' The smallest doses of 
the mildest cathartics have been known to occasion exhausting 
purgation.' ' That there has been for some time an epidemic 
constitution of the atmosphere, and that,, under different states and 
temperatures, it may produce different effects, and give rise to a 
variety of morbid actions according to the predisposition of the 
system at the time, does not, I think, admit of a question of doubt.' 

" Dysentery prevailed extensively in the years of 1851 an J 852. 
During the summer of the last, it was attended with a considera- 
ble mortality, especially among children. 

"The inhabitants of the valleys and creek bottoms suffered 
most. The weather was warm and rather dry during the pre- 
valence of the disease. 

" During the epidemic last summer, diarrhoea prevailed also, 
and not unfrequently was found associated with dysentery in the 
same subject. Copious sanguineous or serous discharges would 
sometimes alternate with dysenteric discharges. This form of 
diarrhoea was usually very prostrating in its effects, and in some 
instances proved suddenly fatal. It was attributed by many to 
the cholera atmosphere then supposed to pervade the greater por- 
tion of the United States. The occurrence of fatal cases of cholera 
morbus at the same time give credibility to this opinion. 

"The months of July and August seldom pass by without the 
occurrence of many cases of bilious dysentery, in some of which 
the influence of malaria is very perceptible. 

"Influenza, or epidemic catarrhal fever, is of frequent occur- 
rence. It may be said to be a regular visitnt of the spring and 
fall seasons, each visitation being characterized by some new pe- 
culiarity. In the fall of 1851 a form of the disease prevailed, 
marked by the following symptoms : pain in the head, back, and 
extremities, cold shivering sensations, deep bronchial cough, and 
occasional slight fever. All of these symptoms were worse in the 
early part of the day. The weather was dry, but had been preceded 
by heavy rains ; previous to the rains there was a great drought. 

u Neuralgic affections are quite common in this country. They 
appear generally to be of malarious origin, and yield to quinine, 
cupping, &c. In the colder seasons the disease is frequently blend- 
ed with rheumatism, and appears to be developed bv exposure 
to cold and damp weather. The facial variety is most common." 



202 The Uses of Chlorate of Potash. [March, 

I have now finished the work assigned to me, to the best of my 
ability, and hope that it may meet the views, and fulfil the require- 
ments of the Association. 

And now, also, I make my acknowledgements, gratefully, for 
the assistance which I have received from those gentlemen of 
the profession who have given me the benefit of their knowledge. 

To Dr. P. M. Kolcock I am indebted for most of the part be- 
longing to the neighborhood of the sea, and through his instru- 
mentality to Dr. Bealer, of Effingham, Dr. Dunham, of Camden, 
and Dr. Hopkins, of Wayne County. 

Dr. H. Briggs, of Troupville, Lowndes County, communicated 
all that I have given of Southwestern Georgia. 

I owe to Dr. G. F. Cooper, of Perry, Houston County, much of 
what I have said of the upper part of the first, and lower part of 
the second division. 

Dr. Robert C. Word is my authority for all concerning the 
third or limestone division. 

I have endeavored carefully to distinguish the parts due to 
each contributor, as vouching for the correctness of whatever I 
have written, whenever it was not from my own observation. 
[Transactions Amer, Med. Association, 1857. 



The Uses of Chlorate of Potash. 

I, On the Therapeutical action of Chlorate of Potash, 

WITH A NEW MODE OF ADMINISTEING IT. By Dr. DETHAN, 

(IJ Union Medicate, and Brit, and For. Med. Chir. Rev. 

II. On the use of Chlorate of Potash in Pregnancy. 
{Liverpool Med. Chir. Journal, and Banking's Abstract.) 

The use of Chlorate of Potash. — In the August number 
of the last volume of this Journal we collected from various 
sources, several articles on the different applications of the Chlo- 
rate of Potash in the treatment of disease. We have since 
made frequent tests of its usefulness, and find that it answers an 
admirable purpose as a lotion, in many cases of leucorrhoea, and 
other affections of the vagina — and also in some cases of stoma- 
titis, either from mercurial salivation or other causes. In one 
instance of sore throat, attended with great fetor, which occur- 
red at the end of a protracted case of Typhoid fever, its appli- 
cation as a gargle, was followe4 by surprising results. We 
understand that Dr. W. L. Felder, of this city, has used Chlorate 



1858.] The Uses of Chlorate of Potash. 203 

of Potash, internally, strength 3j. to 8 oz. water, for twenty- 
years, as a remedy in Typhoid fever. Dose of this solution, as 
used by him, was 1 teaspoonful every three or four hours. The 
strength of the solution used in all of our cases, above-mentioned, 
was two drachms of the salt dissolved in 8 oz. of water. This 
was applied to the affected mucous surfaces four or five times 
during the day, either as a gargle or as an injection, as the na- 
ture of the case required. 

We here present to our readers some other applications of this 
valuable article, and its use in certain cases of pregnancy. We 
do not pretend to explain the manner of its action ; but the facts 
here reported, though not entirely conclusive, are certainly very 
striking, and should at least arrest our attention. 

"Dr. Dethan considers that chlorate of potash is a powerful 
sialagogue, and that its elective action on the bucco-pharjmgeal 
mucous membrane is well marked. To this physiological action 
is added a very remarkable and valuable success in pathology ; 
its rapid and incontestable effects in mercurial salivation, by 
checking the formidable mercurial affection, have permitted 
practitioners to continue the mercury without fear, and thus to 
contend without remission against the constitutional infection. 
As an especial and incontestable remedy in ulcero-membranous 
stomatitis, this medicine need not, according to the physicians of 
the Hopital Sainte-Eugenie, be swallowed ; its topical applica- 
tion is sufficient, and in a short time the mucous membrane 
recovers its normal qualities and functions. Dr. Dethan con- 
cludes that the chlorate of potash, administered under a special 
form, which would permit the local action to be exercised slow- 
ly and certainly, although leaving the medicine to be carried 
into the stomach in a state of solution with the mixed liquids of 
. the salivary, buccal and pharyngeal glands, would be the mode 
of administration which would combine all indications and all 
opinions. He therefore suggests the use of the remedy in the 
form of pastiles, so that the patient may have at hand a remedy 
against the injurious effects of a mercurial treatment which he 
may be undergoing. The experiments of Dr. Ricord, and the 
publications of M. A. Fournier, testify incontestably in favor of 
this successful simultaneous medication. In certain forms of 
angina attended with fibrinous exudations, it prevents the inti- 
mate adherence of the false membranes to the mucous mem- 
brane, and facilitates their expulsion, and assists the action of 
emetics. In this affection the topical action of the chlorate, fa- 
voured by the bruising between the teeth, the natural solution 



204 The Uses of Chlorate of Potash. [March, 

in the liquids of the mouth, and its penetration into all the points 
interested, will be certainly efficacious. In debilitating diseases, 
such as diphtheritis, and gangrene of the mouth, the child will 
find an agreeable and reparative kind of food, together with the 
most appropriate remedy hitherto discovered, against these dis- 



" Every one engaged in midwifery practice will have met 
with cases in which the child is carried successfully into the 
viable period, but some time between this and the full term of 
pregnancy, is born still, or very weakly ; and this perhaps for 
several successive pregnancies, without any external or acci- 
dental cause to explain the premature death and delivery, and 
with no evidence of syphilitic taint in the parents. 

" It is in such cases that Mr. Grimsdale (in accordance with a 
suggestion thrown out some years ago by Dr. Simpson) has been 
in the habit of prescribing chlorate of potass with some appa- 
rent benefit. 

" Case 1. — Mrs. Darbyshire, a stout, healthy looking woman, 
get. 34, was delivered of a female child, after a labor of eleven 
hours' duration, in the Lying-in Hospital, on the 24th March, 
1852. During labor there was a large discharge of very offen- 
sive, dark-colored muddy water ; the nurse told me she filled 
two chamber-pots with it, besides what escaped in the bed. The 
child was with difficulty made to breathe. It was jaundiced 
from birth, and died of hemorrhage from the umbilicus, on the 
seventeenth day. 

" The placenta was diseased ; portions of its maternal surface 
were seen to be of a pale yellowish color, and these were firm 
to the touch, and penetrated nearly to its foetal surface ; at least 
one-fifth of the bulk of the placenta must have been occupied 
with these firm pale portions. The centre of each patch was 
firmer than its circumference, and it seemed to pass insensibly 
and gradually into healthy placental structure, having no accu- 
rately defined boundary. On the maternal surface were also 
several stellated patches of vessels, distinctly gritty to the touch. 

"Dr. Inman kindly examined this placenta under the micro- 
scope, and he did not regard the changes observable in it as due 
to inflammation, neither was it an instance of fatty degeneration. 
This woman had had four previous pregnancies, in which she 
had been attended by a midwife at her own home. The child- 
ren were all still-born, and said to have been yellow. Of the 
state of the after-births I could learn nothing satisfactory. 

"About the middle of April, 1853, the patient came to me, 
stating that she was five months in the family way, and would 
be glad if anything could be done to avoid the birth of another 
diseased child. I gave her chlorate of potass, 5 grains three 



1858.] The Uses of Chlorate of Potash. 205 

times daily, to be increased in a fortnight to 10 grains. She con- 
tinued this with but little intermission to the time of her deliv- 
ery, on the 13th of August, when she gave birth to a healthy 
child, which is now (October, 1855) living and thriving. The 
placenta was large, and quite healthy looking. I may remark, 
that before commencing the chlorate of potass treatment, I made 
careful inquiry as to the probability of any syphilitic taint in 
either husband or wife, and could detect nothing in their histo- 
ry to warrant any suspicion. 

" Case 2. — Mrs. Egan, a poor woman, ael 21, pale and rather 
delicate looking, presented herself at the dispensary of the LyiDg- 
in Hospital, in April, 1855, and stated herself to be four months 
in the family way. She said that she had been four times preg- 
nant before, and had on each occasion given birth to a dead 
child. Her labors had been of no great severity, and of moder- 
ate duration ; the midwile who attended her told me that the 
children were small, and appeared to have been dead some days; 
the after-births, she said, were 'pale in parts, and queer look- 
ing.' The husband was a steady working man. I saw him ; he 
looked strong, and denied having had syphilis. 

" The former pregnancies had been attended with no pain. I 
ordered chlorate of potass, 20 grains a day. She continued this 
for four months. On the 5th September she was delivered of a 
fine healthy child, which is still (October 10th) thriving and 
without ailment. The placenta was large and healthy. 

" Case 3. — Mrs. D., set. 33, of spare conformation, hysterical 
temperament, became pregnant about six months after her mar- 
riage. After quickening, the movements of the child were dis- 
tinct, and increasing in power up to the end of the sixth month 
of her pregnancy ; she then began to feel them decidedly weak- 
er; not much notice was taken of this, as she had no pain, until 
in about three weeks she ceased to feel any movement. I saw 
her, and on examining with the stethoscope, could hear no 
foetal heart sound. In about a week from this she gave birth to 
a dead child, the cuticle of which was beginning to desquamate. 
It was well formed, but the skin was wrinkled, and it looked 
ill-nourished. The placenta was in parts pale, firmer than na- 
tural, and its vessels in these parts deficient in blood. 

"In March, 1853, I again saw her; she was then pregnant 
three months and a half. I recommended her to take the chlor- 
ate of potass at once. She began with 15 grains in the day ; 
she had only taken it three or four days when she complained 
that it made her head ache. I ordered its discontinuance, but 
in a few days again prescribed it without her knowledge ; again 
she complained of intense headache, and I left it off for a month. 
She tried it once more, but declared it gave her a most fearful 
headache, which she could not bear. This second pregnancy 



206 The Uses of Chlorate of Potash. [March, 

followed as nearly as possible the same course as the first, and 
with the same results. 

" In December, 1853, she was again pregnant ; I saw her 
when she was four months advanced, and wished her to try the 
chlorate in smaller doses. She took 3 grains thrice daily with 
impunity ; this was continued for three weeks or a month ; she 
then increased the dose to 4 grains, and subsequently to 5 grains. 
All seemed to go on well. The movements of the child, she 
said, were considerably stronger than in her former pregnan- 
cies. 

" When well into the seventh month, she was riding out in 
her carriage, a low, four-wheeled phaeton, when another vehi- 
cle ran into them, smashed the carriage, and upset its occupants. 
My patient was of course much frightened ; she felt, she stated, 
a violent commotion in her inside for some hours, but after that 
day did not feel any movement. She was from home at the 
time: in two or three days she returned; I then saw her, could 
detect no foetal heart-sound, and believed the child to be dead. 
In ten days from the date of the accident labor came on, and she 
was delivered of a dead child. 

" Nothing could be more marked than the contrast presented 
between this child and its placenta, and those of the two former 
deliveries. The child was plump, and had all the appearance 
of a healthy seven months' child ; the placenta was everywhere 
soft and spongy and its vessels seemed to have been uniformly 
full of blood, 

" This lady became pregnant for the fourth time in the begin- 
ning of October, 1855. About the end of the third month she 
commenced to take the chlorate in 3 grain doses, and gradually 
increased it to 5 grains, thrice daily. She was occasionally com- 
pelled to intermit its use, in consequence of the headaches, as 
before ; but with these exceptions it was persevered in until the 
full time of pregnancy, when she was delivered (June, 1856) of 
a healthy male child, now living (June, 1857). The placenta 
was quite healthy. 

Case 4. — Mrs. , a stout, healthy-looking woman, came to 

me in November, 1854. She was between three and four months 
gone in the family way. She had been seven times pregnant 
before, but had never given birth to a living child. One child 
she carried to nearly the full time; five had been born between 
the sixth and eighth month, and one was aborted at an early 
period of pregnancy. I ordered her to take the chlorate in 5 
grain doses, thrice daily; and after the fifth month especially 
enjoined the immense importance of rest; this latter injunction 
she seemed determined not to comply with. 

" She went on well until February, 1855, frequently stating 
that she felt the movements of the child stronger than usual. 



1858.] The Phosphates in Tuberculosis. 207 

On the 12th, after having kneaded a large pan of dough, and 
performed sundry other laborious domestic exercises, labor came 
on unexpectedly, and she was delivered in five or six hours of 
a living child — the first of all her children that had ever breath- 
ed. It was a breech presentation ; the child seemed of about 
six and a half or barely seven months' development, and only 
lived a few hours. The placenta was healthy. 

"Case 5. — Jane D., set. 86, presented herself at the Lying-in 
Hospital, September 12th, 1853. She said that last year she had 
miscarried at six months, without any apparent external cause. 
The child had been dead some time ; she learned this from the 
midwife who attended her. She was now four months advanced. 
She commenced the chlorate 15 grains in the day, continued it 
on and off during the rest of her pregnancy, and was delivered 
of a healthy child at full time. 

" I have notes of ten other cases similar to this last. I do not 
think they are worth much as evidence; they will, therefore, 
scarcely add to the interest of this paper, and I refrain from giv- 
ing the details. 

"In two cases apparently likely to have received benefit from 
the chlorate, and in which it was exhibited as usual, I failed to 
perceive any favorable result. In one of the cases, death of the 
foetus, and miscarriage, at the seventh month, occurred, as it had 
done in three previous pregnancies. In the other, the child was 
born dead and ascitic, at eight months and a half, the placenta 
being hydropic. The mother had, before taking the chlorate, 
given birth to four still-born children in succession. 

" Of the nature of the diseased action in these cases, I am not 
prepared to say much. It would seem to be located primarily 
in the placenta, and to cause the death of the child secondarily, 
by the consequent effects on the placental function. The mor- 
bid appearances in the placenta would seem to be tolerably 
uniform : I can see no evidence of their inflammatory nature ; 
and there certainly were no previous symptoms indicative of 
inflammation in any of the cases. n 



The Phosphates in Tuberculosis. — If Dr. Churchill's opin- 
ion with regard to the beneficial action of the Phosphates, in 
Phthisis, is correct, of course these remedies will be found appli- 
cable, at least rationally so, in all the other manifestations of the 
strumous diathesis, as the multitudinous affections pertaining to 
the eye, the lymphatic glands of the neck and of the axilla; 
affections of the hip-joint, knee-joint, elbow, and shafts of the 
long bones. — Calculating strongly on the chemical action of 



208 The Phosphates in Tuberculosis. [March, 

medicines within the organism, we are aware, is not always 
safe from disappointment; — that is, practice does not every time 
confirm what theory a/firms; but when experience plainly de- 
monstrates what reason will approve, we may ever feel safe in 
following their joint indications. 

On the Proximate Cause and Specific Remedy of Tuberculosis. By 
Dr. John Francis Churchill. 

The following is the abstract of a paper which was laid before 
the Academy of Medicine at Paris, on the 21st of July, 1857 : 

The total number of cases of phthisis treated by the author 
amounts to 35. All were in either the second or the third stage 
of the complaint — that is, they had either softened tubercles or 
cavities in the lungs. Of these, 9 recovered completely, the 
physical signs of the disease disappearing altogether in 8 out of 
that number; 11 improved considerably, and 14 died; 1 still 
remains under treatment. 

The proximate cause, or at all events an essential condition of 
the tubercular diathesis, is the decrease in the system of the 
phosphorus which it contains in an oxygenizable state. 

The specific remedy of the disease consists in the use of a pre- 
paration of phosphorus, uniting the two conditions of being in 
such a state that it may be directly assimilated, and at the same 
time at the lowest possible degree of oxydation. 

The hypophosphites of soda and lime are the combinations 
which hitherto seem best to fulfil these two requisites. They 
may be given in doses varying from ten grains to one drachm 
in the twenty-four hours. The highest dose which I have been 
in the habit of giving to adults is twenty grains. 

The effect of these salts upon the tubercular diathesis is im- 
mediate, all the general symptoms of the disease disappearing 
with a rapidity which is really marvellous. 

If the pathological deposit produced by the dyscrasy is of 
recent formation, if softening has only just set in and does not 
proceed too rapidly, the tubercles are absorbed and disappear ; 
when the deposit has existed for a certain time, when the soften- 
ing has attained a certain degree, it sometimes continues in spite 
of the treatment, and the issue of the disease then depends upon 
the anatomical condition of the local lesion, on its extent, and 
upon the existence or non-existence of complications. The au- 
thor has made numerous attempts to modify the local condition 
of the lungs by the inhalation of different substances, but has 
never obtained any satisfactory result independent of what was 
to be attributed to the specific treatment. The hypophosphites 
of soda and lime are certain prophylactics against tubercular 
disease. 



1858.] Non-Mercurial Plan of Treatment in Syphilis. 209 

The physiological effects which he has observed to be pro- 
duced by the use of the hypophosphites of soda, lime, potash 
and ammonia, show these preparations to have a two-fold action. 
On the one hand they increase the principle, whatever that may 
be, which constitutes nervous force; and on the other, they are 
the most powerful of hsematogens, being infinitely superior to 
all medicines of that class hitherto known. They seem to pos- 
sess in the highest degree all the therapeutical properties former- 
ly attributed by different observers to phosphorus itself, without 
any of the danger which attends the use of that substance, and 
which has caused it to be almost forgotten as a medical agent. 
The different preparations of hypophosphorous acid will, accord- 
ing to these views, occupy one of the most important places in 
the Materia Medica. — [Dublin Hosp. Gaz. } and Banking's AbsH. 



The Non-Mercurial Plan of Treatment in Syphilis. Read before 
the Western Medical and Surgical Society. By Dr. Cahill. 

He commenced by narrating a number of cases in which the 
constitutional effects of syphilis had been very severe, and had 
extended, in spite of treatment, through many years, in all of 
which the early stage of the disease had not been attacked by 
mercury. After detailing these very carefully, he entered into 
the history of this plan of treatment, remarking that most of the 
Irish surgeons who had adopted it have since changed their 
opinions respecting it. He maintained that the severest and 
worst forms of constitutional syphilis occur when no mercury 
whatever has been given for the primary disease, and that the 
notion that the severe cases of secondary disease are mainly due 
to the mercury administered is not founded in fact. Mercury, 
to be of use, must be persevered in for at least six weeks, and 
to produce its good effects need not to be given lavishly or 
recklessly. If attention be not paid to this fact, no permanent 
effect is produced, and other forms of the disease, as secondary 
or tertiary, are apt to follow immediately after. He recommend- 
ed the use of the bichloride in doses of one-twelfth to a quarter 
of a grain, together with the inunction of the strong mercurial 
ointment, until the gums showed that the system was affected 
by the mercury. The bichloride is borne better than any other 
form of mercury, and can be continued with safety longer than 
any other mercurial preparation, not only in these cases, but 
even in scrofulous diseases, in which its use is advisable; hence 
its peculiar value. Iodide of potassium, given with iodine, is 
the next remedy to be relied upon, though it is chiefly valuable 
in secondary and tertiary affections of the periosteum. In ter- 
tiary symptoms, the iodide is our sheet-anchor, and mercury 



210 Pathology of Convulsions, d-c. [March, 

should never be given in such cases to the extent of producing 
its specific effects; should a mercurial be required, the hyd. c. 
creta is to be recommended in conjunction with the iodide of 
potassium. Iron, arsenic, and mineral acids, under certain cir- 
cumstances, are useful, especially after mercury has been fairly 
tried; these, with the ordinary means of restoring health, as 
good food, pure air, and rest, will generally promote a cure. 
He then alluded to the difficulty of distinguishing primary 
chancre, and the means employed by inoculation, and the pecu- 
liar hardness, of the true Hunterian chancre, and to the chance 
there was of a chancre in the urethra being overlooked, and to 
other sources of error as to the curability of syphilis without 
mercury. He concluded with the following observations : — 

1st. That the severest and most prolonged forms of the disease 
have arisen where no mercury has been given for the primary 
or early secondary affection. 

2ndly. That as no symptoms identical with those of constitu- 
tional syphilis are produced by mercury, the notion 'that mercury 
is a cause of constitutional syphilis is founded in error. 

3rdly. That the administration of mercury may be so regu- 
lated as to preclude any of its severe effects ; and supposing any 
are produced, it is manifest that they would be less severe than 
those caused by constitutional syphilis. 

4thly. That the constitutional effects of mercury should be 
avoided in tertiary syphilis. 

5thly. That the supposed successful treatment of syphilis 
without mercury is founded on erroneous diagnosis, or the cases 
have occurred in individuals already protected, or the subjects 
have been of that class who seem to enjoy immunity from the 
worst part of the complaint. — London Lancet. 



Pathology of Convulsions, with especial reference to those of Children. 
Bead before the North London Medical Society. By Dr. 
Beynolds (of which the following is an abstract) : 

I. All vital actions are accompanied by, and depend on, phy- 
sical changes in the living organism. 

II. Modifications of vital action depend on modified physical 
conditions. Some symptoms of disease are modifications of vital 
actions, and there are two general modes in which they are, or 
may be, related to the nutrition-change : 

1. Negative symptoms — i.e. those which consist in the nega- 
tion of vital properties, such as paralysis, anaesthesia, etc.— may 
depend directly on a" solution of continuity," or some other 
distinct organic disease ; but 

2. Positive symptoms — i.e., those which consist in the altera- 



1858.] Pathology of Convulsions, &c. 211 

tion or excess of vital action — cannot depend directly on such 
textural condition, but must have for their immediate cause some 
modification of the minute interstitial proceasea 

III. Convulsions, being essentially modifications of vital ac- 
tions, must depend on modifications of physical conditions. 
Though no "lesion" is discoverable, we are warranted in the 
conclusion that nutrition is affected. 

IV. Convulsions depend on modified nutrition changes in the 
nervous centres. 

V. The proximate cause of convulsions is the same in all 
cases when the convulsions are the same ; and the lesions dis- 
covered in the nervous centres or elsewhere are not the proxi- 
mate causes of convulsions, for they differ in locality and kind, 
and have no constant proportion to the symptom in question. 

VI. The proximate cause of convulsions is an abnormal in- 
crease in the nutrition changes of the nervous centres — an in- 
crease in relation to time or to mobility. 

VII. The remote causes are such as induce the abnormal 
increase. There are three general modes in which these causes 
operate : 

1. The nervous centres may be involved in a general nutrition 
change — e.g., as during dentition, at puberty, in Bright's dis- 
ease, scrofulosis, rickets, etc. 

2. The nervous centres may be the seat of special disturbance, 
owing to organic lesion, as tumour, spiculae of bone, etc. 

3. Eccentric irritations may affect their nutrition through dif- 
ferent nerves. 

VIII. The diagnosis in convulsions is that of the remote cause, 
and the first step is to ascertain to which of the above three ca- 
tegories the case belongs. In children, the diagnosis will turn 
on: — 

1. The duration of the paroxysm ; 

2. The frequency of its repetition ; 

3. Its local or general distribution ; and, 

4. Interparoxysmal symptoms. 

The last are of the most value ; and the positive or negative 
character of the symptoms, together with local distribution, af- 
ford material assistance in this process. 

IX. The treatment of convulsions is guided by the diagnosis, 
and will consist in the removal or palliation of eccentric irrita- 
tions, the improvement of general nutrition, and the treatment 
of local disease. — [Ibid. 



9* 



212 Editorial, [March 



EDITORIAL AND MISCELLANEOUS. 

Pacific Medical and Surgical Journal. — We have just received 
the first issue of this new journal. The present number, in the character 
of its papers, its style, and typographical execution, gives promise of this 
new comer to our sanctum, being a most valuable addition to the med- 
ical literature of the country. " Every civilized nation," to use the lan- 
guage of its Editors, " has sent some of the boldest and most enterprising 
of her medical scholars, to earn fortunes and fame from the babel popu- 
lation of California. In this city, besides numberless American, English, 
French, German and Italian physicians, there are medical savans of the 
Mongol race, who practice both surgery and medicine." Therefore, we 
repeat, this journal must become an important exponent of a variety of 
medical opinion, and we look forward to its future success with much 
interest. The work is edited by John B. Trask, M.D., and David Woos- 
ter, M.D. It is published monthly, at San Francisco, California, at five 
dollars per annum, and the editors are also the publishers. 

We take great pleasure in placing this new member upon our Ex- 
change List, and in welcoming its editors, cordially, into the fraternity 
of journalists. 



A Manual of Medical Diagnosis : being an Analysis of the Signs and 
Symptoms of Disease. By A. W. Barclay, M.D., Cantab et Edin. 
Fellow of the Royal College of Physicians, Assistant Physician to St. 
George's Hospital, etc., etc. Philadelphia: Blanchard & Lea. 1858, 
Pp. 423, 8vo. 

In the circle of attainments necessary to constitute the rational and 
reliable practitioner, no one of them is more important than a correct 
and philosophical system of diagnosis. Without it, all treatment is em- 
piricism, every measure, a bare assumption, and Therapeutics itself but a 
guess. Of works exclusively devoted to this important branch, our Pro- 
fession has at command, comparatively, but few, and, therefore, in the 
publication of the present work, Messrs. Blanchard & Lea have conferred 
a great favor upon us. Dr. Barclay, from having occupied, for a long 
period, the position of Medical Registrar at St. George's Hospital, pos- 
sessed advantages for correct observation and reliable conclusions, as to 
the significance of symptoms, which have fallen to the lot of but few, 
either in his own or any other country. He has carefully systematized 
the results of his observation of over twelve thousand patients, and by 
hu diligence and judicious classification, the Profession has been present- 



1858.] Editorial and Miscellaneous. 213 

ed with the most convenient and reliable work on the subject of Diag- 
nosis, that it has been our good fortune ever to examine. 

We dislike to recommend any book, except a dictionary as " a book 
of reference," for no author can ever obtain his full meed of considera- 
tion, unless he is read diligently through — page by page : but we are 
aware that in the present unavoidable relations of the practitioner to the 
Science of Medicine, this " reference" phase of a book, is ever a recom- 
mendation ; we can therefore say of Dr. Barclay's work, that from his 
systematic manner of arrangement, his work is one of the best works " for 
reference" in the daily emergencies of the practitioner, with which we 
are acquainted ; but, at the same time, we would recommend our read- 
ers, especially the younger ones, to read thoroughly and study diligently 
the whole work, and the " emergencies" will not occur so often. 



To Readers and Correspondents. — We have on our table, many 
other valuable works, pamphlets and communications, kindly sent us by 
publishers and correspondents. The notices of these, together with other 
important editorial matter, have necessarily been excluded from our pre- 
sent number, on account of the engrossing duties imposed upon us at 
this season, by our relations to the Medical College of Georgia. Still, it 
will be seen that, we have done some work for the present issue, as the 
original and eclectic department will show. 



Professor Means. — As in the January number of this journal, we 
announced that our friend, Professor Alexander Means, had resigned the 
Chair of Chemistry in the Atlanta Medical College, we now state that 
Professor Means has subsequently withdrawn that resignation, and, there- 
fore, retains his connection with that institution. 

Professor Means has since, resigned the Chair of Chemistry and Phar- 
macy in the Medical College of Georgia. 

The candor of Professor Syme, in making this correction through the 
London Times, is truly commendable and worthy of imitation, by all 
members of our profession, under like circumstance. There is true man- 
liness in it. 

An Excision of a Mail's Tongue. — The following letter has been ad- 
dressed, by Professor Syme, to the editor of the Times : " I regret to 
learn that an operation which I happened to perform in the Royal Infir- 
mary of Edinburg has got into the newspapers; but as it has unfortunate- 
ly done so, the public should be correctly informed on the subject. Par- 
tial removal of the tongue, for the remedy of Cancer, having been found 
worse than useless, it was thought that extirpation of the whole organ 
might afford effectual relief; upon this principle I proceeded. The pa- 



214 Editorial and Miscellaneous, [March, 

tient suffered no bad consequences directly from the operation ; but at 
the end of a week, when the external wound was quite healed, died sud- 
denly from an internal disease, which might have been excited by any 
other irritation in a person of his constitution and habits." 



Novel Method of Extracting a Foreign Body from the (Esophagus. — 
We have before us, in the pages of the Boston Medical Journal, an 
account of an extremely ingenious and novel method of extracting a 
foreign body from the oesophagus, by Dr. David Rice. " Mrs. Field, a 
lady aged 70, while eating chicken soup, accidentally swallowed a piece 
of bone the size of an American quarter of a dollar, cut into a triangu- 
lar form. The bone lodged in the oesophagus, about two inches below 
the top of the sternum. Thinking that it might fall into the stomach, 
she neglected to apply for surgical aid, until the fifth day after the acci- 
dent. In the mean time, she had swallowed neither food nor drink, 
both regurgitating back into the mouth with every attempt to do so." 

The Doctor was called on the fifth day, but was unable to remove the 
foreign substance by any instrument which he had at his command. 
He finally took a piece of sponge of such a shape, as when dry, to fill 
about half of the tube, and introduced it rapidly in a dry state, then, by 
introducing a little water into the mouth, the sponge became moistened, 
and enlarged it to twice its natural size, completely filling the gullet. 
On drawing it out the bone was brought with it, much to the gratifica- 
tion of patient and practitioner. 

There is a certain readiness of invention and expedient which is neces- 
sary to a surgeon, and without which he will often be nonplused and 
harassed. The same means cannot be applied to every case, and com- 
mon sense, with a share of ingenuity, frequently is all that is necessary 
to overcome difficulties which seem to be very great. It is desirable to 
have in our minds the expedients which have been resorted to by others 
in difficult cases, for we are liable at any time, to have a case to which 
they are precisely applicable. We conceive that this mode of swabbing 
the gullet from below upward, by introducing a dry sponge below a 
foreign body, allowing it to imbibe moisture and then withdrawing it, 
might be applicable to a great many cases where the substance could 
not be removed by other means. — [Buffalo Med. Journal. 

[We add, from memory, to the above, a very ingenious device of Dr. 
E. Leroy Antony, of Georgia, for removing a certain kind of foreign 
body from the throat. The patient by some means had swallowed a 
fish-hook ! (what will not people swallow ?) it had passed out of reach 
and became fixed in the gullet by the barbed end, in the efforts of the 
patient to relieve himself by pulling at the line which was attached to 
the hook and hung out of the mouth. Dr. A. removed the foreign body 
by passing a drilled bullet down the oesophagus upon the line, which, 
when it arrived at the hook-end, disengaged the barb, and protected the 
soft parts from being wounded with it, during its removal from the 



1858.] Miscellaneous. 215 

throat. As Dr. Flint remarks, " it is desirable to have every possible 
expedient in our mind" — this last is also one which certainly deserves 
recording and recollecting.] 

Surgery in San Francisco. — Dr. E. S. Cooper, of this city, has recent- 
ly ligated the primitive carotid artery in two cases, — the external iliac 
in one, the axillary in one, removed a large fibro-cartilaginous tumour 
from the uterus ; made the Caesarian section in one ; exsected parts of 
three ribs, and removed a foreign body from beneath the heart ; exsected 
the sternal extremity of the clavicle and a portion of the summit of the 
sternum ; together with the exsection of nearly all the joints, in different 
cases, all successfully. 

This embraces a list of formidable operations, which, being attended 
with favorable results, are worthy of note. This uniform success in 
operations of such magnitude, must, in part, be attributed to the effects 
of our climate, which, for the recovery of patients after receiving serious 
injuries, is, at least, unsurpassed in any part of the w< 

There have been many other capital operations succ 5sfully performed 
in various parts of this State, which we are unable, for want of data from 
the operators, to specify. There is no country in the world, where, in 
the absence of war, mutilation and deformities from injuries are so com- 
mon and so serious, as in California ; and it is n emarkable 
that our surgeons have opportunities of practice which can be found only 
in the hospitals of other countries. — [Pacij 



On the Temperature of the Body in Intermittent Fever. By Dr. S. Th. 
Michael. — These observations were made in different types of intermit- 
tent fever, and repeated at intervals of five minutes, so as to determine 
with exactness the precise variations of temperature. 

Their result is that the temperature begins to rise at the rigor, and rises 
by slow degrees; and that after this it falls by slower degrees, and with 
intermissions. At the commencement of the rigor, and at the end of 
the period of sweating, the temperature is below the natural standard, 
sometimes to the extent of some degrees, sometimes to certain portions 
of a degree. 

In the majority of cases, the maximum elevation was between 32° and 
33° Reaumur, rarely below, more frequently above. The highest point 
ever attained was 33.4 Reaumur. 

After the administration of sulphate of quinine the temperature did not 
attain to the same degree of elevation as previously ; and during conval- 
escence it remained below the normal standard, or only occasionally be- 
came raised to the fraction of a degree above it. — [Archivfur Physiolog. 
Heilkunde. Ranking $ Abstract. 



Glycerine in Corns. — These troublesome things Mr. TVakley is in the 
habit of treating, at the Royal Free Hospital, by the application of gly- 
cerine, which has the effect of soft (filing them, when they are easily 
scooped out. We saw as many as -<\enteen corns entirely removed in 
twelve days in this manner. — [London Lancet. 



216 Miscellaneous. [March, 

"On the Signs of Pregnancy? — It seeins strange that Dr. Montgome- 
ry should have deemed it necessary to write so elaborate a treatise on 
this subject, when the old sage of Cos summed up the whole matter in 
three lines. Thus, in the 41st Aphorism of Hippocrates, we find the 
following : 

" If you wish to know whether a woman is pregnant or not, instead 
of supper, give her hydromel (water impregnated with honey) at bed- 
time ; if she experiences griping pains in the abdomen, she is pregnant ; 
otherwise, she has not conceived." 

Hippocrates, in another place, refers to a matter of some importance 
in its bearings on the duration of pregnancy. He states that his own 
father knew not his mother for two years before his birth ! We believe 
that the Roman law was somewhat liberal in cases of ])rotracted gestation, 
"but the Greeks must have had some very peculiar notions on the subject, 
if they i rauked the birth of this reputed 18th lineal descendant of^Escul- 
apius" (the latter, son of Apollo,) among the legitimate ! — [ Western 
Lancet. 



Rev. Sidney Smith on Hag Fever. — In a letter to Dr. Holland, the 
eccentric Dean of St. Paul, thus gives his personal experience in this 
complaint : 

k> I am suffering from my old complaint, the hay fever (as it is called.) 
My fear is, perishing by deliquescence ; I melt away in nasal and lachry- 
mal prorluvia. My remedies are warm pediluvium, cathartics, topical 
applications of a watery solution of opium to the eyes, ears, and the in- 
terior of the nostrils. The membrane is so irritable that light, dust, con- 
tradiction and absurd remark, the sight of a Dissenter — anything — sets 
me sneezing ; and if I begin sneezing at twelve, I don't leave off till two 
o'clock, and am heard distinctly in Taunton, when the wind sets that 
-way — a distance of six miles. Turn your mind to the little curse. If 
consumption is too powerful for physicians, at least they should not suf- 
fer themselves to be outwitted by such little upstart disorders as the hay 
fever;— [Ibid. 

Anaisthesis by " Projection? — To avoid the accidents due to excessive 
inhalation of the anesthetic agent, and especially to insure that the ma- 
terial should be mixed with the requisite amount of air, Dr. Heurteloup, 
known in surgery for the invention of Lithotripsy, has contrived an ap- 
paratus for this end, (having in hi> experiments made use of chloroform). 
The apparatus is like a syringe with a small bellows for throwing in air 
in place of the piston, and having a gauze partition on which the chloro- 
form is poured. The working of the bellows throws a steam out of the 
small end in a jet, which contains more or less chloroform, according as 
the discharging tube is brought more or less near to the bellows. The 
jet is established only on working the bellows, and there is no waste of 
chloroform during the operation. — [American Jour, of Sci. and Arts. 

Incontinence of Urine. — M. Trousseau seems to have most unboun- 
ded confidence in the efficacy of Belladonna in the treatment of incon- 
tinence of urine. A girl ast. 19, entered the hospital, who voided her 



1858.] - . ' 

urine two or three times during the night. He commenced with 1 cen- 
tigramme (gr. .1543 Troy) of the extract, and in the course of a few 
weeks, increased the dose to 18 centigrammes. He insists upon the 
continued use of the medicine for several months after the incontinence 
had ceased, as a return of the difficulty may otherwise be anticipated. 

[ Western Lancet. 

A New Property of Camomile. — Camomile {anthemis nobilis) is de- 
scribed in all treatises of materia medica as emollient digestive, fortify- 
ing. <fcc but none point out a most precious virtue, just announced as 
pertaining to it by M. Ozanam, whose paper on the subject was presented 
to the Academy of Sciences at its last sitting by M. Cloquet. This vir- 
tue consists in preventing suppuration when the local disease is not too 
far advanced, and in gradually stopping it when it has existed for a long 
time. For this purpose it is administered in powerful doses of five, ten* 
and even thirty grammes of the flower in a litre of water, the infusion 
to be drunk in the course of the day, and to be continued until the cure- 
be effected. Compresses moistened with the infusion may be locally 
applied ; they aid in the cure, but are not necessary — the infusion alone 
taken internally, being quite sufficient. In support of his assertion, M. 
Ozanam quotes a number of cases in which this mode of treatment was 
successful. — [London Times. 

On the use of Manganate of Potass as a Caustic in Cancer. B7 
TVeedox Cooke. — Mr. Weedon Cooke speaks highly of manganic acid. 
in combination with potassa as a base, as the caustic in the treatment of 
cancer. It produces, he says, much less pain than any other caustic, and 
no ill-consequences of any kind. It is a dark-green powder, which may 
be dredged on the ulcerated surface by means of a pepper-castor. 

[Lancet. 



Duration of Cancer. — A case of some interest presented itself at the 
Cancer Hospital, on the 25th of August, in the person of a female, aged 
seventy-four years, the subject of cancer of the left breast for twelve 
years. She had been a patient at this hospital since its foundation, with 
this exception of the last three years, during which time she had been in 
good health. She came to show an ulcerated tuberculous mass in the 
same breast, the size of a small pear, otherwise the disease has dried up 
and disappeared. She still looking a hale and hearty old woman. — [lb. 

MedicalJoumals in the United States. — We think there is a crrowin<r 
disposition to lessen the number of our medical journals — to improve 
their quality — and a decreasing disposition to publish them for nothing: ! 
lianiiest improvement in the tone and character of almost 
all our exchanges, and we notice that several have already raised their 
price: we think these features in our journalism are pioper and com- 
mendable. Medical periodicals, if published at all, must be paid for in 
some way — and if afforded to subscribers at a price actually less than 
the paper and printing cost, somebody roust make up the deficit, 
this can very readily be afforded sometimes, by parties who have special 



218 Miscellaneous. 

interests to advance, just on the same principle that we get a flood of 
almanacs annually thrust under our doors gratis, for the sake of calling 
our attention to their author's individual skill, or wonderful nostrums; 
but we doubt if the true interests of legitimate medicine are to be ad- 
vanced by the publishing of our journals on such principles. 

[Cincinnati Lancet and Observer. 



Artesian Wells in Sahara. (Athen., No. 15G2.) — The Moniteur Al- 
gerien brings an interesting report on the newly-bored Artesian wells in 
the Sahara^Desert, in the province of Constantine. The first well was 
bored in the Oasis of Oued-Rir, near Tamerna, by a detachment of the 
Foreign Legion, conducted by the engineer, M. Jus. The works were 
begun in May, 1856, and, on the 19th of June, a quantity of water of 
4,010 litres per minute, and of a temperature of 21° Reaumur, rushed 
forth from the bowels of the earth. The joy of the natives was unbound- 
ed ; the news of the event spread towards the South with unexampled 
rapidity. People came from long distances in order to see the miracle ; 
the Marabouts, with great solemnity, consecrated the newly-created well, 
and gave it the name of "the well of peace." The second well, in Te- 
makin, yielded 35 litres, of 21° temperature, per minute, and from 
a depth of 85 metres ; this well was called " the well of bliss." A third 
experiment, not far from the scene of the second, in the Oasis of Tamelhat, 
was crowned with the result of 1 20 litres of water per minute. The Mara- 
bouts, after having thanked the soldiers in the presence of the whole 
population, gave them a banquet, and escorted them in solemn procession 
to the frontier of the Oasis. In another Oasis, that of Sidi-Nached, which 
had been completely ruined by the drought, the digging of " the well of 
gratitude" was accompanied by touching scenes. As soon as the re- 
ioicino: outcries of the soldiers had announced the rushino- forth of the 
water, the natives drew near in crowds, plunged themselves into the 
blessed waves, and the mothers bathed their children therein. The old 
Emir could not master his feelings ; tears in his eyes, he fell down upon 
his knees, and lifted his trembling hands, in order to thank God and the 
French. This well yields not less than 4,300 litres per minute, from a 
depth of 54 metres. A fifth well has been dug at Oum Thior, yielding 
108 litres per minnte. Here a part of the tribes of the neighborhood 
commenced at once the establishment of a village, planting at the same 
time hundreds of date-palms, and thus giving up their former nomadic 
life. The last well is that of Shegga, where soon an important agricul- 
tural centre will spring up. There is no doubt but that these wells will 
work in these parts a great social revolution. The tribes* which, after 
the primeval custom of their ancestors, kept wandering from one place to 
another, will gather round those fertilizing springs, will exchange the 
herdsman's staff for the plough of the farmer, and thus take'the first steps 
towards a civilization, which, no doubt, will make rapid progress in Nor th- 
em Africa. — [American Jour, of Science and Arts. 



The Boston Transcript says, the following by Oliver W. Holmes, is 
the finest simile ever written : " The mind of a bigot is like the pupil of 
the eye ; the more light you throw upon it, the more it contracts." 



SOUTHERN 

MEDICAL AID STJBGICAL JOUMAL. 

(NEW SERIES.) 

Vol. XIV.] AUGUSTA, GEORGIA, APRIL, 1858. [No. 4. 

ORIGINAL AND ECLECTIC. 

ARTICLE IX. 

A Lecture upon Hemorrhoidal Affections. By L. A. DuGAS, M.D., 
Professor of Surgery in the Medical College of Georgia. — 
Taken down by J. F. B., medical student. 

Gentlemen : 

I will direct your attention to-day to the subject of Hemor- 
rhoids, commonly called the Piles. And in order that you may 
understand the anatomical relations of the parts implicated, I 
have brought before you these very handsome models of dissec- 
tions of the rectum, exhibiting its blood-vessels, nerves, muscles, 
&c. It is not my intention to enter upon a minute description 
of these structures, but I merely desire that you may keep your 
eye upon these models, in order that you may understand more 
readily what I have to say upon the disease under considera- 
tion. 

Hemorrhoidal affections show themselves in different forms. 
In some the disease consists essentially in a varicose condition 
of the hemorrhoidal veins, with or without a similar amplifica- 
tion of the capillaries and arterial radicles, and is entirely con- 
fined to parts above the verge of the anus. This, therefore, 
constitutes what is commonly called internal Piles, in contra- 
distinction of another variety called external Piles, in which, as 
the term indicates, there are external manifestations of the disease 
in the form of one or more small globular tumors of a deep red 
or bluish hue, situated at the verge of the anus. These two 

K.S. — VOL. XIV. NO. IV. 10 



220 Dugas. Lecture on Hemorrhoidal Affections. [April, 

forms of the disease are attended with a very considerable de- 
gree of vascularity in the mucous membrane of the lower end of 
the re&um, and, not unfrequently, with a relaxation of this 
membrane, more or less marked, which may in some cases allow 
it to protrude during the expulsory efforts of defecation. 

The hemorrhoidal tumors to which we have referred, may be 
formed either by an extraordinary dilatation of the veins, or, 
what is-more common, by an exudation of blood into the subcu- 
taneous cellular tissue. If the opening from which the blood 
has issued be sufficiently free, the blood contained in the little 
sac or tumor may remain fluid ; but if, on the contrary, the 
blood has been derived from mere capillaries, it may coagulate. 
Hence it is that, upon opening these tumors, we sometimes find 
them filled with a coagulum, whereas in other instances nothing 
issues but liquid blood. It is thus, also, that we may account for 
the fact that while in some cases these tumors may be dissipated 
by pressure, in others they do not diminish in size by this means. 
When the extravasated blood has become thus coagulated, it op- 
erates somewhat like a foreign body, and provokes more or less 
inflammatory action of a very painful character. In general, 
however, after the painful stage of the disease, occasioned by the 
distention of the tissues, has ceased, the coagulum dissolves and 
is gradually removed by absorption, with the exception of small 
fibrinous concretions, which remain in the form of slight indur- 
ations, sometimes projecting beyond the general level of the parts 
These little indurated teats will sometimes become chafed and 
exquisitely sensitive, giving the patient a great deal of annoy- 
ance long after the subsidence of the acute symptoms. 

You have all heard of persons said to be affected with blind 
Piles, and others with bleeding Piles. The term blind Piles is 
applied simply to those hemorrhoidal affections which do not 
bleed — whereas the bleeding Piles are those in which the con- 
gested blood-vessels relieve themselves by an issue of blood 
during defecation, and occasionally at other times. Now this 
issue of blood usually occurs from the mucous membrane just 
within the sphincters, although it may sometimes flow from 
the verge of the anus. When it occurs during defecation, it 
is manifestly induced by the expulsory efforts, which very 
materially increase the turgescence of the mucous surface. It 



1858.] Dugas. Lecture on Hemorrhoidal Affections. 221 

is therefore important, in such cases, that these efforts be not 
prolonged unnecessarily, in order that the hemorrhage may not 
be excessive, and by its daily repetition seriously impair the 
patient's health, as is too often the case. In the cases in which 
the bleeding does not coincide with defecation, it is most apt to 
take place when the patient is standing or walking, and conse- 
quently when the vessels are exposed to the gravitating influence 
of the superimposed column of blood. It will therefore very 
rarely occur when the patient is in the horizontal position. In 
some very rare instances the hemorrhage proceeds from above 
the sphincter ani, and may accumulate in the rectum until it 
produces a desire to stool, when the patient may pass off a large 
quantity of blood in a state of semi-coagulation. And this may 
be repeated at intervals so short as to become alarming. I have 
seen two cases of the kind which proved very troublesome. In 
general, however, the flow of blood shows itself externally, and 
it may sometimes be felt trickling down the thighs of the patient 
as he walks along. 

Hemorrhoidal affections are often complicated with prolapsus 
ani, or a ^disposition on the part of the lower end of the rectum 
to protrude during defecation, or whenever the patient remains 
long in the erect position. This adds very much to the annoy- 
ance of the disease, as well as to the difficulty of its manage- 
ment. 

I have now given you the leading features of this disease, and 
you may perhaps expect me to say something of its causes, or 
rather of its remote causes. I may as well tell you at once that 
\ do not know them ; and yet, hemorrhoidal affections are sup- 
posed by some to be induced by hepatic disease obstructing the 
portal circulation, and consequently inducing a congestion of 
the veins constituting the origin of the vena portarum. We are 
not told, however, by the advocates of this theory, why it is that 
the blood-vessels of the rectum suffer more under such circum- 
stances than those of the other portions of the alimentary canal. 
Moreover, we know that a very large majority of those affected 
with hemorrhoids furnish us no evidence whatever of hepatic 
derangement. Hemorrhoidal affections are also attributed to 
constipation _and to sedentary habits; whereas every practi- 
tioner of observation is aware that they very often occur in 



222 DuGAS. Lecture on Hemorrhoidal Affections. [April, 

persons whose bowels are perfectly regular — that they not un- 
frequently occur during a relaxed condition of the bowels, and 
that they affect the active as well as the sedentary. The fact is, 
Gentlemen, that this is a very common disease, at least in this 
part of the world ; and I do not think it an exaggeration to say 
that eight persons out of ten, between the ages of twenty-five 
and fifty, suffer more or less with this infirmity. I should have 
said white persons ; for it is a remarkable fact, that our negroes 
are so rarely affected with this disease that I do not recollect to 
have seen more than two or three of them suffering with it, in a 
practice of five and twenty years, although one half of our popu- 
lation consists of this class of people. Whether this exemption 
of the negro race can be traced to any anatomical peculiarity or 
not would be a subject of interesting inquiry. 

You must have observed, that I restricted the liability to this 
disease to the period of life extending from the twenty-fifth to 
the fiftieth year. I did so, because it very rarely shows itself 
before twenty-five years of age, and that it usually declines 
and ceases to be troublesome at about fifty years of age. We 
know, that with the advance of age the rectum, and especially 
its lower extremity, diminishes in capacity and in relaxation, 
often to such a degree as to render the act of defecation more 
or less difficult, and even to make it a source of real annoy- 
ance to the very aged. This species of atrophy may perhaps 
account for the cessation of hemorrhoidal troubles with ad- 
vancing age. 

With regard to the treatment of this disease you will find 
quite a diversity of opinion in the profession, and no lack of 
specifics in the newspapers of the day. I need not detain you 
with a critical appreciation of the various plans suggested, but 
will at once proceed to give you the course I usually pursue in 
the management of these affections. This must necessarily vary 
according to the circumstances of the case. At the commence- 
ment of the disease, it usually shows itself in the form of attacks 
more or less acute, which, after having continued a few weeks, 
will gradually subside, leaving the patient under the impression 
that he is cured, and will not have any return of the affection. 
It is then that he is willing to certify to the efficacy of the last 
remedy used, especially if he has procured it from a Charlatan 



1858.] DuGAS. Lecture on Hemorrhoidal Affections. 223 

or nostrum vender. But the occurrence of one attack is almost 
invariably the precursor of others, after the lapse of months or 
even years. A knowledge of this fact should make you ex- 
ceedingly cautious in your prognosis, and you will always be 
on the safe side if you will honestly state to your patient that 
although you may relieve him, you cannot promise a radical 
cure, or an immunity from subsequent attacks, unless the patient 
be near the age at which the disease will probably cease spon- 
taneously. 

These acute attacks are generally attended with the formation 
of one or more hemorrhoidal tumors at the verge of the anus, 
intensely painful during the act of defecation. The pain con- 
tinues after defecation, and the patient complains of a sense of 
burning and throbbing in the part affected, which is increased 
by the erect position, but may even continue to annoy him 
when in bed, to such a degree as to prevent any quiet sleep 
during the night. We have here the usual manifestations of 
inflammatory action, set up by the effusion of blood in the sub- 
cutaneous cellular tissue and the influence of distension. It is 
under such circumstances that we find the patients resorting to 
the various pile ointments heralded by the newspapers, or using 
some similar application under the direction of their medical 
adviser. These ointments usually consist of a combination, in 
various proportions, of opium or some of its preparations, with 
finely pulverized gall-nuts or other vegetable astringents and 
sugar of lead or alum, rubbed up with lard or simple cerate. * I 
must confess that I have never derived any advantage from 
these applications, and that I believe that the popular error in 
regard to their efficacy is the result, as already intimated, of 
their use at the period at which the disease is about to subside 
of itself. The same may be said of the use of rhubarb lozenges, 
sulphur, cream of tartar, and other remedies in popular favor. 
During the intensity of the disease the application of leeches is 
highly recommended by some, and may afford temporary relief, 
but the leech bites will sometimes rather increase than lessen 
the pain. I am in the habit of directing, in such cases, that the 
patient shall remain in bed — that the bowels be emptied by a 
full dose of rhubarb, and then kept quiet for several days by the 
use of small doses of opium. The preference is given to rhu- 



224 Dugas. Lecture on Hemorrhoidal Affections. [April, 

barb over other cathartics, and especially over saline cathartics, 
because the discharges it occasions are less excoriating. Under 
the effects of a dose of salts the dejections are as painful as 
though the patient were passing boiling water over the affected 
part. Poultices of corn -meal, or of bread and milk, should be 
hept constantly applied to the anus, either hot or cold, accord- 
ing to the preference of the patient. It is somewhat singular, 
that while some patients derive most relief from hot applications, 
others, on the contrary, find them intolerable and are materially 
benefitted by the cold. Certain poultices are supposed by some 
to be peculiarly beneficial, and I have known cases relieved by 
the application of the leaves of plantain, rue, or wormwood, 
bruised in the form of a poultice, after other applications had 
failed. Poultices made with infusion of red oak bark will also 
be found sometimes advantageous in the latter stages of the 
attack. If there be any protrusion of the intestine, this should 
be anointed with a little sweet oil, or sperm oil, (which is less 
apt to be rancid,) and gently forced up by the patient with his 
fingers as often as it may occur. This procc-ss, which is some- 
times very painful, will be very much facilitated if the patient 
will place himself upon his knees and breast so that his pelvis 
may be elevated and allow the rectum to gravitate towards the 
abdomen. I have already advised that the bowels be kept quiet 
after having been emptied, but when this is no longer compati- 
ble with the comfort of the patient, the rectum may be washed 
out with cold water ; or, if he cannot tolerate the introduction 
of the canula, he should take a smaller and merely laxative dose 
of rhubarb, to be followed, as before, by the opiates. My object, 
you perceive, is to avoid as much as possible the disturbing and 
irritating influence of defecation. The patient should therefore 
use animal food, which leaves less fecal matter than vegetable 
substances. Under these directions the attack will usually run 
its course with as little suffering as possible ; but you will now 
and then find cases in which the unmitigated pain may warrant 
a trial of other means, such as sitting over boiling water, or steam 
generated by pouring water upon a hot brick. This will some- 
times give considerable relief, and may be repeated as often 
as the patient's inclination may direct. I have sometimes 
known the so-called u Pain-killers " to act advantageously in 



1858.] Dugas. Lecture on Hemorrhoidal Affections. 225 

subduing the morbid sensibility of the parts. These nostrums, 
you know, consist of a concentrated tincture of capsicum and 
morphine, or of capsicum and morphine mixed with lard. The 
liquid is the better preparation of the two. When applied, it 
occasions intense smarting for a-while, which gradually sub- 
sides and may leave the patient considerably relieved. 

In the acute attacks, attended with bleeding, there may or 
not be any protruding tumors, and the hemorrhage usually pro- 
ceeds from the mucous surface above the verge of the anus. In 
these cases the act of defecation is more or less painful, and there 
is a disposition on the part of the patient to make strong expul- 
sory efforts, not unlike those provoked by a mild attack of dys- 
entery. And it is then that the blood issues either in a distinct 
jet or stream, which will cease with the act of defecation. The 
lower end of the rectum and the verge of the anus may become 
very sore, as though chafed by the contact of the feces. 

In treating acute attacks of this kind, I would adopt the same 
plan as above indicated, with the exception of the poultices, in 
lieu of which I would advise ablutions with cold water, or sitting 
a few minutes in cold water three or four times each day. 

"We now come to the consideration of the treatment of the 
disease when chronic, and of the rules to be observed between 
the acute attacks. In the first place, let the patient be fully im- 
pressed with the importance of keeping his bowels perfectly 
regular, that is to say, of having one stool every day : nothing 
will conduce more to bring about this state of things than the 
observance of a stated hour at which he will invariably go to 
stool, whether he feels any desire to do so or not. If he finds 
that he cannot have an evacuation naturally, or that he is com- 
pelled to make strong expulsory efforts to accomplish his pur- 
pose, he should throw up a small quantity of cold water into the 
rectum, ten or fifteen minutes before the appointed hour. By 
so doing, he will find that the bowels will gradually acquire the 
desired habit of punctuality. The patient should bear in mind 
that nothing is more injurious to those subject to Piles, than 
long sitting and protracted efforts at stool. He should therefore 
not remain more than a few minutes, and make but slight ex- 
pulsory efforts, and if he cannot thus promptly and readily emp- 
ty the rectum, he should desist and wait until the next day, 



226 Dugas. Lecture on Hemorrhoidal Affections. [April, 

being careful not to allow this to interfere with his regularly 
appointed hours. 

The selection of the hour is not a matter of indifference, for 
if this be fixed in the early part of the day the injurious effects 
of defecation will continue to be felt, or even become aggravated 
by the erect position and exercise during the remainder of the 
day. If, on the contrary, this act be performed at night, or just 
before retiring to bed, the horizontal position will favor the sub- 
sidence of the congestion, and the restoration of the parts to 
their normal condition. Without a due observance of these 
little matters of detail, especially in cases attended with a dispo- 
sition to protrusion, all your other directions will often fail to 
give relief. Again, the patient should use cold water ablutions 
on rising from bed, and on retiring at night; and if the case 
be troublesome, this should also be done at noon, especially 
during the summer. 

You will sometimes be consulted for cases of long standing, 
in which the protrusion of hemorrhoidal tumors or of folds of 
the intestine will have become almost habitual, at least when the 
patient is in the erect position. In these cases, if the patient is 
compelled to attend to his business, it may become necessary to 
resort to mechanical means of support. The patient should 
wear during the day, and sometimes even during the night, an 
anal supporter, which may be made as follows :— Let a belt be 
carried around the body so as to rest upon the hips, and buckle 
in front ; attach to the back part of this, a strap, which is to pass 
down to the perineum and here bifurcate, so that one end will 
pass on each side of the scrotum, and be buckled to the belt in 
front. To that portion of the perineal strap which corresponds 
to the anus, the anal supporter should be fixed. This may con- 
sist of a ball of cotton thread about an inch and a half in diame- 
ter, and covered with oiled silk for the purpose of cleanliness ; 
or it may be made of wood, well polished, and of the shape of a 
half globe, the convexity being towards the anus. This maybe 
oiled and easily kept clean. By applying this bandage with 
sufficient firmness, the patient may attend to his business with 
very little inconvenience, until the means above recommended 
shall have had time to improve the condition of the parts. 

You perceive, Gentlemen, that I have thus far recommended 



1858.] Felder, on the Uses of Chlorate of Potash. 227 

no surgical operation in the management of these affections ; 
but you will recollect that I have repeatedly endeavored to in- 
culcate the doctrine that the duty of the surgeon is not so much 
to perform operations as it is to avoid their necessity. And yet 
there are several surgical procedures recommended in the differ- 
ent stages of this affection. For instance, it is advised by some 
to lay open, to excise, or to ligate the hemorrhoidal tumors. I 
have never had occasion to resort to either of these expedients, 
except in those cases in which small indurated teats continue to 
fret the patient. I then clip them off with a pair of scissors. 
The use of ligatures is unjustifiable in any event, as being more 
painful and hazardous than cutting instruments. You will find 
it recommended by high authorities to excise the protruding 
portion of the mucous membrane, or to apply to these, concen- 
trated nitric acid, and even to destroy them with the actual 
cautery. "While these practices may perhaps be justifiable in 
hospital practice, where the hygienic observances I have advised 
cannot be enforced, I have never been compelled to have re- 
course to them, nor do I think it probable that you 1 will be less 
fortunate, if you should think proper to adopt my views. 



ARTICLE X. 



Remarks on the 4 Uses of Chlorate of Potash. By W. L. Feeder, 
M. D., of Augusta. Ga. 

[We are much pleased to find that the casual reference to our 
friend's name, in connection with the above subject, in our last 
number, has resulted in so valuable a report of his personal ex- 
perience in the therapeutical applications of Chlorate of Potash. 
We may really feel encouraged to try the same device on some 
other occasion. — Edts.] 

Messrs. Editors — In your issue of the March number of the 
Southern Medical and Surgical Journal, I find my name men- 
tioned in connection with an article, or a few remarks of yours, 
upon the subject and use of the Chlorate of Potash. I do not 
complain of your having done so, but if I had known of 
your intentions, or had thought for a moment that you were 



228 Felder, on the Uses of Chlorate of Potash. [April, 

acquainted with the fact of my having long since used the 
medicine, I would certainly have given you all the information 
in my power upon the subject of its use, and my experience 
with the remedy, and thus have saved the necessity of intruding 
myself upon your notice, or of appearing upon the pages of your 
Journal. In as much, however, as you have thought proper 
(from some source of information, which I can readily imagine) 
to advert to my use of the article in a limited and imperfect 
manner, I would beg leave to exercise the privilege of being 
correctly reported, as to the quantity used and the diseases for 
which I have administered it. 

Chlorate of Potash has long since been a favorite remedy with 
me in the treatment of almost every form of fever, and especial- 
ly in those periodical fevers denominated remittent, or, as they 
are called in some places, " Country fevers" or " Santee fevers." 

My attention was drawn to the remedy, specially, in August, 
I think, eighteen hundred and thirty- two, in the Case of a youth, 
then, by the name of Gr***** L***, who was under treatment for 
remittent fever by Dr. H. I was requested to visit the patient 
with the attending physician. I thought that the Chlorate of Pot- 
ash would admirably suit the case, and fill all the purposes then 
indicated ; accordingly, I gave it in the following manner : — 
R . Chlorate of Potash, 2 drachms ; Infusion of Serpen taria Yir- 
giniana, 8 ounces. Of this, a tablespoonful was given every two 
or three hours, until its discontinuance should be ordered. It 
had a "fine effect, and in three or four days he was in a situation 
to take quinine and brandy also, and he speedily recovered. I 
have used it also in typhoid fevers, (symptomatic, for I do not 
believe in the idiopathic forms of typhoid,) with the finest re- 
sults, and believe that under some circumstances, it constitutes in 
the list of remedial agents one of the very best remedies, and 
exerts an influence in low forms of fever that no other remedy 
possesses. 

In these low forms of fever it is used as recommended above, 
although I find it necessary sometimes to combine with it a little 
tinct. opii. acetat. The dose for an adult is a tablespoonful eve- 
ry two or three hours: less to younger persons — about the 
quantity you represent in your article at my hands. 

I have used the remedy repeatedly in Scarlet fever, and espe- 



1858.] Felder : on the Uses of Chlorate of Potash. 229 

cially in the malignant forms, both internally and as a gargle for 
the ulcers about the mouth and throat I consider its use im- 
portant, however, in any of the varieties of Scarlet fever, and 
when properly administered, will produce its full share of benefit. 
It is used as above advised in these affections, when taken in- 
ternally ; but when used as a gargle, I make it much stronger, 
and use it with Sage tea, if convenient, in preference to the 
Snake-root tea, — it is a matter of very little consequence, how- 
ever, whether used with either — a little cold water will answer 
every purpose to dissolve it. As a cleanser of ulcers, especially 
after the use of the Xit. silver, it has no superior. From three 
to four drachms of the potash with eight ounces of pure water, 
or with either of the teas, is the usual strength in which I have 
used it. I would not hesitate, however, to use it much stronger^ 
either externally or internally. I have applied it to indolent 
ulcers of the legs, and in one instance to a chronic ulcer of long 
standing, with much benefit, in the form of powder. I have 
likewise used it in obstinate cases of salivation from mercury 
with decided benefit, and in one case, especially, that seemed to 
baffle every other remedy, and threaten the life ef a very inter- 
esting child, who had been worse salivated than I ever saw one, 
before or since ; it relieved and healed the ulcers kindly, and I 
believe was the only remedy, out of many, that saved her life. 
The case, however, resulted in very great deformity, and has 
been a source of great unhappiness to the individual who ad- 
ministered the calomel. He was unacquainted with the action 
of mercury and "did not know that it would make the mouth 
sore, much less produce sloughing," and thereby permanently 
entail miserable deformity. 

In the various vaginal irritations and ulcerations of the os and 
cervix uteri, it will exert a very happy influence, and may be 
relied upon, if perseveringly used, in counteracting leucorrhceal 
discharges produced from irritations, and very often heal such 
ulcers promptly. 

In a case of ulceration of the os and cervix, in which I tried it 
for a very long time in this city, its effects were accompanied 
with results highly flattering, and the patient seemed to be ra- 
pidly recovering, until neglect of her person, growing out of the 
fact that she was not able to have the care and attention that 



230 Musgrove. Cases of Poisoning. [April, 

such cases require, and consequently the local affection became 
aggravated, her constitution failed, and the case terminated in 
death. I was not in attendance at the time of her death, nor 
had I been for many months previously, consequently can 
say nothing upon the subject of her condition at the time of her 
death. 

I have said all that I conceive to be prudent and proper in 
an article of this sort ; however, I could mention much more 
concerning its effects in that scorbutic or spongy condition of 
the gums, accompanied with hemorrhage, in typhoid fever. 

I am now treating a child with ulcerous sore mouth, with this 
salt of potash, and as soon as I satisfy myself fully of its use in 
gangrenous ulcerations about the mouth as well as the aph- 
thous conditions not only of the mouth, but extending to the 
pharynx and along the oesophagus to the stomach and bowels, 
I may trouble you at some future time, with a publication 
setting forth my views of the utility of this salt in the two last 
mentioned conditions, &c. 

By reference to an article of mine upon Yellow fever, pub- 
lished in the Southern Medical and Surgical Journal, for 1855, 
October number, the use of Chlorate of Potash in the treatment 
of that disease will be seen. 



( ARTICLE XI. 

Poisoning by Phytolacca} Radix (Poke Root)— -four cases. Re- 
ported by ~W. C. Musgrove, M.D., of Midville, Ga. 

Messrs. Editors, — I have been intending, for some time, to 
write an article for the Journal, but want of time has been the 
chief cause of delay in my so doing ; and, even now, I shall 
wish it considered a u resume" of my practice for the month of 
January — a generality rather than a speciality. 

The month of January has been a peculiar one with us — 
spring-like — very wet, and but few cold days. By reference to 
my weather register, we have had — 

Rain, Cloudy, Fair, Variable, 

7 days. 11 days. 11 days. 2 days. 



1858.] MrsGROTE. Cases of Poisoning. 231 

The diseases usual to the season have been wanting : it is true, 
we have had catarrhs, but as yet I have seen but three cases of 
pneumonia, two of which were typhoid. The cases which have 
been under treatment for the month, may be classified thus : — 

Apoplexy 1 Chronic Gastritis 1 

General Nervous Irritability 1 Delivery of Placenta 2 



Miscarriage (3 months) 1 

Midwifery 7 

Do. Twins, (male and female). . 1 

Reducing Luxation Humerus 1 

Erysipelas 1 

Typhoid Fever ... 1 

Pneumonia 3 



Puerperal Fever 

Dj-srnenorrhoea 

Asthma 

Convulsions 

Congestion of the Brain 

Phytolacca Radix, Poisoning by 3 

Fraeture Right Ramus of Pubis. 1 



The detail of some of these cases would be not altogether un- 
interesting. I send you now, however, only the case of poison- 
ing by the Phytolacca^ Radix (Poke Root) : 

January SO. Visited four negro children, belonging to Mr. 
J. S. J.; found three of them extended on a blanket before the 
fire, almost cold and pulseless, narcotized', the pupil contracted ; 
the muscles greatly relaxed, as in a very drunken man ; the 
breathing slow, and scarcely any motion in respiration percept- 
ible. About 1 o'clock, P.M., the little negroes were taken with 
vomiting, which continued, at intervals, until I saw them, at 6 
P.M. They were aged 10 years, 8 years, 4 years, and 16 
months. The eldest was relieved by the emesis, and the young- 
est was severely hypercaihar sized. 

Prescription. — Boiled milk, cold, in small quantities ; as soon 
as the stomach was quieted to give a dose of oil and turpentine, 
and stimulate with beef-broth and brandy. " Rubbing the cold 
surfaces with dry mustard, and if re-action was not induced, to 
use spts. turpentine, mustard cataplasm for the youngest, and 
carb. ammonia. 

January 31. Found 10, 8 and 4, convalescing finely, but 
the 15 months child sinking — dying about 10 A.M. 

The children had been eating the Poke Root, mistaking it 
for the Artichoke. There was no convulsive action in these 
cases. 

[As the Poke Root is an abundant product of our Southern 
States, and the liability to poisoning by it very great, we regard 
Dr. Musgrove's brief report as quite important to practitioners 
in these regions. — Edts.] 



232 Lecture on Influenza. [April, 



Clinical Lecture on Influenza. By W. T. Gairdner, M. D. 
Physician to the Eoyal Infirmary, and Lecturer on Clinical 
Medicine, Edinburgh. 

I invite your attention to-day to a subject of great importance, 
and very directly suggested, not perhaps by any one case now in 
the wards, but by a combination of circumstances which you 
have witnessed during the last fortnight. It is to the prevalence 
of certain diseases in our hospital wards, which, taken collective- 
ly, amount to the proof of an epidemic morbid tendency ; that is' 
to say, which show, by the extent and manner of their diffusion, 
the existence of a morbid influence operating temporarily upon 
the population at large. I cannot, indeed, show you in the wards 
a single typical case of this epidemic disorder, as it is seen so fre- 
quently outside, unless it be that of the woman just admitted into 
the fever ward. But, although I cannot place before you the 
ordinary forms of the epidemic (because these are commonly too 
mild to be admitted into hospital,) I can show you its accidents 
and complications in sufficient number to furnish a text for some 
remarks on its nature and prevalence. 

You may recollect that, at the beginning of the month, we had 
very few acute cases of disease, though there were many interest- 
ing chronic cases, chiefly of abdominal affections, and almost 
all of organic diseases. The few acute cases that we had were 
fevers, and these almost all of one kind, viz., enteric typhus, about 
which I may have more to say at another time. Now, on the 
other hand, the wards are crowded with more or less acute cases 
of disease ; and most of these diseases are of the chest. Let me 
enumerate a few of them. 

There is the case of the woman already noticed as having been 
admitted to the fever ward. She is a healthy -looking young 
woman, who has been occupied as a domestic servant. She was 
seized, a few days ago, with shivering, succeeded by headache, 
pains in the limbs, sickness. Along with these there was a cer- 
tain amount of catarrh, which has now settled (not very severely 
however) upon the chest. The fever is now intense, and very 
much out of proportion to the severity of the catarrh. Headache 
persists, the skin is hot, the tongue loaded, the color dingy, and 
the general aspect of the patient certainly goes far to justify her 
being sent to a fever ward. Nevertheless, I believe it will turn 
out not to be a case of fever, in the ordinary acceptation of the 
term ; but of the current epidemic — which I will take the liberty 
of calling, if it has not already been called — Influenza. 

Had this been the first case of influenza presented to my notice, 
it might have passed for one of continued fever or typhus. But 
even then I should have remarked its singularly abrupt invasion, 



1858.] Lecture on Influenza. 233 

the great amount of prostration in this early stage, the extreme 
severity of the headache and articular pains, as being rather out 
of character in any fever to which we have lately been accustom- 
ed. Knowing what I do of other cases, I have no doubt these 
symptoms are owing to influenza. The only question is. whether 
this woman may have influenza and fever combined. This ques- 
tion must remain open for the present. 

Now, by considering this case of catarrhal fever, or of feverish 
cold (if you like to call it so,) in relation with the other facts to 
which I shall allude presently, you will draw for yourselves the 
picture of the epidemic, as we have it. 

The first indication we had of anything out of the usual course 
was, perhaps, that downward tendency of several of our cases of 
phthisis, which, you will recollect, I remarked to you more than a 
fortnight ago. It does not always happen that cases of phthisis 
are the first to show a tendency to influenza, and in this instance, 
it may have been a coincidence ; but it is a curious coincidence, 
that, when we had picked out four cases of phthisis as fit subjects 
for trying the new remedies — the hypophosphites of lime and 
soda — and had noted them carefully for that object, three out of 
the four should have been seized with acute symptoms, within a 
short period of our commencing the novel treatment. I told you 
at the time, that I had no reason to blame the remedy for this 
result, and that it was probably a mere coincidence ; I am now 
disposed to believe that it was one of the first manifestations of 
the morbid influence of which we have since seen so much. 

[Two of these patients have since died ; one went out relieved ; 
another survives, considerably enfeebled, but without acute symp- 
toms.] 

On the 11th ol November, we saw together a casein the 
female general ward, of very old-standing chest disease, apparently 
emphysema of the lungs, in which acute symptoms had super- 
vened, and the patient appared to be in extreme danger from res- 
piratory oppression, with feverishness and bronchitis. Under a 
very simple treatment, this woman is now improving; but her 
case is, no doubt, one of the epidemic in a debilitated subject. 

Shortly before this case was admitted, a bov was brought to 
the waiting-room screaming with pain, which he referred to his 
left side. He was also very feverish. He had not much catarrh, 
but auscultation left us in no doubt that there was a degree of dry 
pleurisy on the left side, and also a friction sound, not so well 
marked, over the pericardium. Under moderate leeching and 
opiates, he was soon convalescent; but the respiratory friction 
sound continued loud and characteristic, and we have detained 
him in the ward mainly for your benefit. I had some doubts, at 
first, whether this boy had not suffered perforation of the lung ; 
but it was not so. I do not say it was a well-marked case of in- 
fluenza, but I mention it by the way. 



234 Lecture on Influenza. [April, 

The next case was that of a boy from the Industrial School, 
who had gone through a distinct attack of feverish catarrh before 
we saw him. The traces remained in the form of bronchitis of the 
smaller tubes, or rather, I suspect, a tubercular condition of the 
lung, with bronchitic signs. This boy has probably had an un- 
sound chest for some time. He is better, however; indeed nearly 
well. 

About this time, I thought it right to pay a visit to the Indus- 
trial School, as I had seen several cases of feverish disorders from 
thence, which the head-master sent up for my inspection. I 
found thirteen or fourteen boys smartly ill with cold of the head 
or chest, and several of them plainly very feverish. Coughs re- 
sounded on every side ; and squill mixture, with paregoric and 
ipecacuanha, were greatly in demand. None of the cases were, 
however, dangerous. 

On November 14th, I directed your attention to a very acute 
case of bronchitis, or broncho-pneumonia, admitted two days be- 
fore. The fever was very intense on admission, but had quite 
subsided, before you saw the patient, under the treatment by con- 
siderable doses of tartar emetic, employed by Dr. Yellowlees from 
the commencement. The patient, a young girl of seemingly sound 
constitution, recovered rapidly — the large doses of tartar emetic 
being replaced by a simple cough mixture, with small doses of 
antimonial wine, after the lapse of about 48 hours; as soon, indeed, 
as the fever shows signs of retreating. No other medicine was 
required in this case. 

Very different was the result of treatment, or rather of the 
neglect of treatment, in another case in the same ward. A young 
woman, the mother of a family, was seized with acute bronchitis, 
and lay many days neglected. She was then seen by Dr. Watson, 
who after blistering the chest and administering some internal 
remedies, sent her into the hospital. In this case, seen by us 
only at an advanced stage, the fever had assumed a hectic char- 
acter. Occasional flushes overspread the face ; there was marked 
dyspnoea and lividity ; sweating was very severe every night, 
and sometimes in the day ; and prostration very considerable. 
She has since had acidulous drinks, antispasmodics and opiates, 
and is better; but her convalescence is very slow, fever is not 
subdued, and I greatly fear that the seeds of tubercular disease 
have been laid in this case. She flushes whenever she is spoken 
to, and is very nervous. [This patient was lately dismissed, as 
she felt it necessary to go home to her family ; but she is very 
unfit for household duties, and will probably be so for some time.] 

Two other cases of chronic catarrh, with acute exacerbation, 
were admitted into the male ward, and were seen by you on 
November 18th. Both of these were street-porters, and men 
above 60 years of age — by no means temperate in their habits. 
I will not, however, dwell upon them. 



1858.] Lecture on Influenza. 235 

The same day, November 18th, brought under your notice, for 
the first time, two extremely interesting cases of acute disease, 
having the imprint of the epidemic tendency. 

One of these was a case of acute pneumonia, or pleuro-pneu- 
monia, in a previously healthy man of 28 years of age. The dis- 
ease had run a course of many days previous to admission, having 
begun in symptoms altogether like simple influenza, succeeded, 
at the end of a week, by pain in the right side of the chest and 
difficulty of breathing, with shivering fits. We found the whole 
lower lobe on the right side more or less consolidated, the sputum 
rusty, and the fever considerable. The night of admission, before 
treatment had been well begun, pain occurred on the opposite 
(left) side, at the lower part ; and this aggravation was attended 
with a pulse of nearly 140 in the minute, at one period, and with 
respirations between 50 and 60 in the minute. So soon, however, 
as the tartar emetic began to take effect, these symptoms subsi- 
ded ; and next day we noticed the pulse at 78, and the respira- 
tions at 32, the skin cool and moist, and the general state quite 
satisfactory ; though a certain amount of dull percussion, with 
some consonating rale, existed at the lower part of the left lung, 
and the physical signs on the right side were unchanged. In 
another day, the line of dull percussion in the right lateral region 
was lower by an inch and three quarters, and from this period 
the convalescence may be said to have begun. The operation 
of the grain-doses of tartar emetic here was most prompt and sat- 
isfactory ; and as the fever and dyspnoea have entirely subsided, 
the pulse being 72 and the respirations 26 in the minute, I am of 
opinion that we may now suspend the remedy, and leave the cure 
to be completed by nature. [The convalescence was uninterrupt- 
ed. The patient left on 2d December, perfectly well] 

The other case which we saw for the first time on the 18th, 
was that of a woman in the fever ward. This patient, a domes- 
tic servant, aged 28, of rather corpulent habit, always enjoyed 
good health till a fortnight ago. At that time she was seized 
with pains in the head, back, and limbs, with a feeling of lassitude 
and exhaustion, which confined her to bed for three or four days ; 
but at the end of that time she was somewhat better, and tried to 
resume her ordinary work — to very little purpose, as in a day or 
two more she took to bed again, and has been feverish ever since. 

I believe that this case is one of enteric typhus, or typhoid 
fever as it is often called. I make this diagnosis, however, chief- 
ly on the ground that certain rose-colored spots, which you saw 
me mark on the skin yesterday, bear a strong resemblance to the 
characteristic eruption of that fever. Should these spots contin- 
ue to appear, we shall feel sure of our diagnosis ; although there 
is at present not a trace of abdominal complication, and all the 
more prominent symptoms are thoracic, so that there is little doubt 
10* 



236 Lecture on Influenza. [April, 

the epidemic tendency is showing itself strongly in this woman. 
There are, in fact, the following very formidable symptoms : — 
great acceleration of the respiration ; dingy lividity of counten- 
ance, with flushed cheeks ; small and very frequent pulse ; con- 
siderable pain in the chest, not localized ; some delirium ; and I 
have little doubt that some peculiar form of broncho-pneumonia 
is present, as there is a scanty sputum, deeply tinged with purple 
blood, and we find, on examination, limited dullness on percussion, 
together with consonating respiration and rale in both backs, at 
the lower part of the lungs. It is easy to see in this case enteric 
fever, complicated w r ith influenza, and with very serious, though 
ill-defined, acute diseases of the lungs — a very ominous conjunc- 
tion, and all the more so as the debility of the patient forbids the 
employment of active remedies, and we must confine the treat- 
ment to regulated stimulation. I must say, that the state of this 
woman appears to me perilous in the extreme. 

[The sequel of this case justified our fears. On the 21st she 
was visited, on account of my unavoidable absence from town, by 
Dr. W. Begbie, who marked out additional rose-spots, thus re- 
moving all doubts as to the diagnosis. The chest symptoms, 
however, still predominated ; there had only been one stool, and 
that a natural one, since admission ; and there was no pain or 
tenderness of the abdomen to any appreciable extent. On the 
night of the 21st a very loose stool was passed containing blood. 
Another followed next day, and another the succeeding night, 
the blood being in large quantity, notwithstanding the application 
of ice to the abdomen, and the administration of acetate of lead, 
w r ith opium, internally. On the 23d, at visit, she was manifestly 
sinking. She had been very restless and delirious, and had three 
other stools, largely composed of blood. The tongue was dry 
and brown, and the pulse almost imperceptible. There was no 
additional embarrassment of breathing, and I did not examine 
the back ; but over the right front there was marked dulness on 
percussion, with feeble tubular respiration and consonating rale. 
She died on the morning of the 24th. 

Post-mortem examination showed numerous enlarged and con- 
gested patches of Peyer in the ileum, in a state of ulceration and 
sloughing; with enlarged, congested and softened mesenteric 
glands. The lungs were in an extremely curious and almost in- 
describable condition ; the right lung almost entirely devoid of 
air, flaccid, evidently collapsed, but showing throughout, on sec- 
tion, much congestion, and here and there patches of haemorrha- 
gic condensation ; the bronchi loaded with mucus deeply stained 
with blood. In the left lung there was a good deal of collapse at 
the base and root ; but on the whole, not much disease. In 
neither lung was there anything like ordinary hepatization, and 
the pleurae were quite smooth, and free from exudation. The spleen, 
as usual, was large and soft. 



1858.] Lecture on Influenza. 237 

It is worth noticing, that the nurse of the ward, a most careful 
and attentive person, was under the impression that this patient 
was menstruating two or three days before death, and that the 
patient herself had a similar impression. The examination of the 
uterus and ovaries showed that this impression was erroneous. 
The mucous membrane was pale throughout ; a gelatinous mass 
of mucus occupied the cervix uteri, and there was no recent cor- 
pus luteum. It is evident that the stains of blood from the bowels 
had led to a mistake in this particular.] 

The only other case worth mentioning in illustration of the 
epidemic tendency, is that of a little girl, admitted on the 19th, as 
she had been several times before, on account of disease of the 
heart. She has, I think, a contracted mitral orifice ; and with 
this there is associated, at present, a great deal of lividity, with 
feverishness, and marked prostration of strength ; the consequen- 
ces, no doubt, of influenza acting upon organs predisposed to dis- 
ease. I should think badly of this case if I had not seen it before ; 
but this girl has repeatedly got over attacks considerably worse 
than the present in a very short time. She had all that elasticity 
of constitution which appears to be the exclusive endowment of 
youth ; and she is in every respect a very good and hopeful little 
patient. [She recovered in a few days.] 

Let me now review these facts. Here, within the space of less 
than a fortnight, you have seen admitted into our wards (with an 
average population under 40) no fewer than 11 cases of febrile 
disease, associated with pulmonary symptoms of one kind or other. 
Most of these, no doubt, were complicated cases, and only one of 
them could be called simple influenza. But this is because simple 
influenza is usually too rapid and too mild a disease to be admit- 
ted to an hospital. We see here, not the disease, but the conse- 
quences and complications of the disease. j In private and in dis- 
pensary practice we see the disease itself. 

[Of these 11 cases of chest affection, 
1 was double pleuro-pneumonia ; 

1 was pleurisy and pericarditis ; 

2 were very acute bronchitis, or broncho-pneumonia, in one 

with a probable tubercular complication ; 
1 was sub-acute bronchitis, certainly with tubercular ante- 
cedents ; 

3 were sub-acute bronchitis, supervening an old emphysema 
of the lungs ; 

1 was sub-acute bronchitis, supervening upon old valvular 
disease of the heart ; 

1 was enteric typhus, with very acute pulmonary complica- 
tion; and 

1 was influenza, pure and simple.] 
While we have been watching these cases together, I have 



238 Lecture on Influenza. [April, 

seen many and heard of many more, cases of the simple and ordin- 
ary form of the disease. Not a few of yourselves have had it, 
and two or three have been seriously ill. Most of the cases that 
I have seen, however, have been remarkable for the sharpness and 
suddenness of the attack, and not less so for the rapidity of the 
passage from a state of feverish prostration to convalescence. I 
have found a man with a pulse of 130 at night and next day he 
has been up and about. This, of course, only happens with sound 
constitutions. In one or two instances, it has appeared to me 
that an emetic, given in time, has anticipated or cut short the 
attack. Certainly it has been followed by great relief. For the 
rest, the bed, or, in mild cases, the sofa, restricted diet, laxatives 
where required, and liberal doses of opium where there is much 
restlessness and exhaustion, seem to me to comprise all the neces- 
sary treatment of ordinary cases of influenza, even when severe. 
In the complicated cases no rule can be laid down. Some are 
very amenable to remedies, others run their course in spite of 
treatment. You have seen illustrations of both kinds in these 
wards. 

The most characteristic symptoms of influenza are intense 
feverishness, usually with great tendency to chilliness or shiver- 
ing, until the patient takes to bed, and reaction is fairly establish- 
ed. Then come racking headache, with pains in the back and 
limbs, which sometimes constitute the principal source of suffer- 
ing; extreme sensation of debility; total prostration of appetite, 
with less of thirst than is usual in fever ; and with these, coryza 
or mild catarrh, bronchitis, broncho-pneumonia, as the case may 
be. But though catarrh is frequent, and may be severe, the 
disease is essentially a fever, not a catarrh. Nay, the catarrh may 
be absent, or insignificant ; not infrequently it is so. In one of 
the cases I saw among yourselves, there was absolutely no ca- 
tarrh ; in another it was very slight. And I saw two very 
curious cases a few days since, which enable me to put this point 
yet more strongly. The catarrh may, in fact, be absent in the 
very case in which you would a priori, expect its occurrence. A 
gentleman, who has been long afflicted with spasmodic asthma, 
with intervals, however, of fair good health, and with no appreci- 
able organic disease of the chest, came to me after he had been 
struggling for several days with debility and prostration, with chil- 
liness and feverish sensations. These were with him the only 
manifestations of influenza. [He afterward, at an interval often 
days, had a slight cold in the head, without fever ; in the mean- 
time his whole family sickened with feverish colds, some of them 
with chest affection, from which he himself remained exempt 
throughout.] In another case, a gentleman, who also suffers 
from habitual asthma and bronchitis, and in whom I suspect a 
morbidly enfeebled heart, sent for me in a great hurry on account 



1858.] Lecture on Influenza. 239 

of the alarming prostration, produced by this strange and inex- 
plicable "influence." He was, however, more friqhtened than 
hurt ; in a couple of days he was convalescent, and the amount 
of bronchitis in his case never gave me the slightest uneasiness. 

Even the complications in influenza are not always of a catarr- 
hal kind, nor even confined to the chest. Ten years ago, in con- 
nection with a great and general epidemic of influenza, I witness- 
ed in this hospital a succession of cases such as I have never seen 
since that time. In the course of a few weeks there occurred, I 
forget exactly how many, but upward of half a dozen cases of in- 
flammation of all the great serous membranes conjointly — double 
pleurisy, pericarditis, peritonitis. Most of them were fatal ; indeed, 
they seemed to come into the house only to die ; so rapid, so in- 
controllable were the symptoms, that no time was given for the 
application of remedies, even had remedies been clearly indica- 
ted. 

It is somewhat remarkable, that the great epidemic influenza 
of 1847-8 began at the same time of the year with the present 
one, almost to a week. You will find an account of it in the 
excellent monography of Dr. Peacock, of London.* That epidem- 
ic however, came upon a population wasted by typhus and other 
forms of fever, and not yet recovered from the famine and desti- 
tution caused by the blight of the potato, and the high price of 
grain in 1845-6. Scurvy, dysentery, and fever, preceded the 
influenza on that occasion, and cholera followed not very long 
after. Notwithstanding the recent money-crisis, and the distress 
likely to follow among certain classes of the working population, 
we may hope that we are at present more favorably situated than 
we were ten years ago. A short time will show whether the 
present epidemic is to bear comparison with the last or not. Hith- 
erto it has been of a very mild character, comparatively speaking. 
I have myself seen only one fatal case — a man who had been for 
some time in poor health, and who died of a chest complication, 
not very unlike that of our case of enteric fever. I do not know, 
indeed, that this can fairly be called a death from influenza, though 
I believe influenza to have been mixed up with the fatal result. 



{From a Clinical Lecture on Friday, November 27th, 1857.) 

Since I spoke to you about influenza a week ago, there have 
been only two additions to the list of acute diseases which appear 
to have had their origin in it — one a case of pleuro-pneumonia, 
admitted only two days ago, treated both before and after admis- 
sion by calomel and opium, and already in process of resolution ; 
the other a case of genuine influenza, with all the usual symp- 

* On the Inflnenza, or Epidemic Catarrhal Feyer, of 1847-8. London 1848. 



240 Lecture on Influenza. [April, 

toms, and which like the former one, was sent up to the fever 
ward, as lying under suspicion. I have directed her to be put in 
the closet, apart from the other patients ; and we shall make a 
point of parting with her as soon as possible. So far as the 
wards are concerned, the epidemic does not appear to have made 
rapid progress this week. 

I have received the Kegistrar-General's report of mortality in 
London for the week ending November 21st. It is worth while 
to compare the indications in this report with those derived from 
our own observation as regards Edinburgh. For this purpose, I 
have drawn up a table of those diseases whose mortality appears 
to be notably above the average of the season, and have calcula- 
ted the existing mortality as against the corrected average of ten 
years. The correction I speak of is made thus : — The Registrar's 
table gives the mortality of each disease during the forty-seventh 
week of the present year, and during the corresponding week of 
ten previous years ; from these he deduces an average, which 
occupies a separate column. But before you can use this aver- 
age as against the number of the present year, you must in every 
case raise it by one tenth, to make allowance for the increase of 
population, which, it is calculated, increases by one tenth in five 
years. 

Now, the past week has in London been one of unusual mor- 
tality for the season ; seeing that the corrected average for ten 
years makes the total mortality of the forty-seventh week of the 
year 1211 ; while during the past week it has been 1382. This 
very considerable extra mortality appears to be due chiefly to 
bronchitis, pneumonia, and phthisis, to which may be added 
whooping cough. All of these are 20 or more in excess of the 
average mortality of the season ; and bronchitis is in excess by 
the very large number of 123, showing a mortality much more 
than double the corrected average of the ten years. These four 
diseases together have a mortality 188 in excess of the average ; 
while the entire excess of deaths for the week is only 171 ; the 
difference being, of course, made by diseases which are below the 
average, especially typhus, scarlatina, and smallpox, which have 
at present a low mortality. The other diseases which, though to 
a smaller extent, have contributed notably to raise the mortality 
of the past week above the corrected average, are — croup (with 
which I have included laryngitis,) scrofula (the disease of the 
young,) and apoplexy, with paralysis, the diseases of the aged ; to 
which we may add that somewhat vague condition called atrophy 
(mostly infantile,) and that still more vague cause of death called 
age. Both of these are considerably in excess ; and these with 
the other causes stated, go to show that the mortality of the past 
week in London has fallen heavily on the two extremes of life. 
This indeed is always the case with influenza. 



1858.] 



Lecture on Influenza. 



241 



But are we justified in assuming the existence of influenza as 
a cause of death in these cases, especially when we look to the 
fact, that not more than 9 deaths are recorded in all London du- 
ring the past week., as having occurred from influenza ? I think 
we are ; because we may be sure that an epidemic condition 
which raises the whole mortality by one seventh, which more 
than doubles the deaths from bronchitis, and largely increases 
those from other acute diseases of the chest, while the aged and 
the young, the apoplectic, paralytic, and consumptive, suffer out 
of proportion to the rest of the population — such an epidemic con- 
dition, I say, has essentially the characters attributed to influenza, 
bv whatever name it may be called. The small number of deaths 
under the special head of influenza, therefore, is only one proof 
out of many that the Registrar-General need not have been at the 
trouble of making a separate class of what he calls zymotic or 
epidemic diseases. The epidemic tendencies of a given period 
must be sought, not in any particular class, but in an intelligent 
consideration of the whole mortality list. Medical men are slow 
to report a death from influenza when it can be properly placed 
under any other title. It is, however, the fact (as 1 know from 
other sources,) that influenza has been unusually prevalent in 
London. 

Table deduced from the Registrar-General's Returns (London) 
for the week ending November 21, 1857 ; showing the rate of 
mortality in the forty-seventh week of the year 1S57. in regard 
to those diseases which are above the corrected average of the 
same week for ten years : 



Whooping cough 

Croup and Laryngitis. 

Influenza 

Scrofula 

Phthisis 

Apoplexy 

Paralysis , 

Bronchitis 

Pleurisy , 

Pneumonia. 

Atrophy 

Age...'. 

All Causes , 



Average 
Mortality. 


Actual 
Mortalita. 


Excess 


Excess 
percent. 


33.5 


53 


20 


58 


13.4 


26 


13 


94 


3 


9 


6 


— 


6.5 


13 


7 


— 


137.6 


159 


21 


15 


25.6 


33 


1 


29 


22.7 


31 


8 


36 


103.6 


227 


123 


118 


2.6 


7 


4 


— 


104.2 


127 


23 


22 


30.6 


38 


7 


24 


49.6 


57 


7 


15 


1211.4 


1382 


171 


14 



Additional Remarks, Dec. 19th. — The epidemic mortality in 
London appears to have attained its culminating point, in the 
week ending December 6. in which the mortality from all causes 
was 1428; from bronchitis 242, from pneumonia 129, and from 
phthisis 168. Considered with reference to the season, however, 
this mortality is by no means so much in excess as that indicated 



242 Lecture on Influenza. [April, 

in the above table ; and we may therefore possibly conclude, that 
the epidemic has passed its maximum in London. The next week 
shows a considerable decline. It is worthy of remark, that all 
the gentle hints and solicitations of the Registrar-General in the 
Weekly Reports, have not succeeded in raising the cypher of in- 
fluenza above 22. In the year 1847, the stated deaths from influ- 
enza for the corresponding week were 198, those from bronchitis 
343, from pneumonia 306, and from all causes 2454. The epi- 
demic of 1847-8 was, therefore, immensely more fatal than the 
present one, so far, at least, as we have hitherto gone. 

It appears from the returns of the Registrar-General (London) 
for the quarter ending September, 1857, that the mortality from 
acute diseases of the chest was considearbly below the average 
during the past autumn. It began to exceed the decennial aver- 
age, however, in the month of October ; and during the latter 
week of that month and the beginning of November, the increase 
was considerable, although not such as to give a decidedly epidem- 
ic character to the mortality. It was only in the second week of 
November that the total mortality began to be decidedly in excess 
of the decennial average. 

In Scotland, the Registrar-General's returns show a very large 
advance on the mortality from pulmonary diseases during the 
month of November, 1857, as compared with the preceding month. 
Thus, in October, the deaths from bronchitis in the eight princi- 
pal towns of Scotland were only 76, while in November they were 
151, or almost exactly double. Pneumonia in the same period in- 
creased from 53 to 76 ; while phthisis has only advanced from 212 
to 228. The increase, as regards brnnchitis, is most marked in 
Aberdeen, next in Greenock, next in Dundee, next in Glasgow, 
and next in Edinburgh. Influenza scarcely appears in the returns, 
numbering only 3 in October, and 7 in November. 

The weather was, on the whole, fine in November, and not 
very dissimilar from that of the preceding month. The barome- 
tric pressure was somewhat higher than in October, viz., 30.143 
inches against 29.817 inches. The mean temperature was nearly 
six degrees less, viz., 45°. 1 against 51°. 0, The rainfall was some- 
what greater, and there was somewhat more of easterly winds. 
It is worthy of remark, that the mean developement of ozone, as 
tested at Greenock, was decidedly less in November than in Octo- 
ber. 

It would be interesting to know to what extent the inland dis- 
tricts of Scotland have been affected with influenza, and whether 
its manifestations have been simultaneous with those in the cities 
or not. From circumstances which have incidentally come to 
my knowledge, I am inclined to believe, that in some places in 
the neighborhood of Edinburgh the appearance of influenza, in an 
epidemic form, was considerably later than in the city itself. 

[Edinburgh Med. Jour. Boston Med. and Surg. Jour. 



1858.] Report on Practical Medicine. 243 

PRACTICAL MEDICINE. 

[Professor Austin Flint has prepared for the North American 
Medico-Chirurgical Keview, the following report of selections 
from various Journals. The six following papers are some of 
those which refer to Fevers, and we transfer them to our pages 
for the benefit of our readers. 

No man in this country has contributed more, in the way of 
faithful statistical observation to the department of Fevers, and 
no one, in our opinion is better prepared, than Dr. Flint to re- 
cord what is truly valuable on the subject, for the consideration 
and guidance of others. 

" The purpose of this report," says Dr. Flint, "is to notice the 
more important of the contributions to practical medicine, con- 
tained in the medical literature during the past year," 1857. 

Fever articles are ever acceptable to practitioners in a Fever 
region, and we, therefore, make no further apology for our se- 
lections below. — Edts.] 

Report on Practical Medicine for the year 1857. By Austin Flint, 
M. D., Professor of Clinical Medicine and Medical Pathology 
in the University of Buffalo. 

Remitting Fever of Children. — In a paper read at a meeting 
of the Society of Statistical Medicine, in the city of New York, 
Dr. J. Lewis Smith presents some considerations in reference 
to the nature of the disease denominated infantile remitting fever, 
and to the proper mode of treatment. 

The most eminent European writers (Barthez, Billiet, and 
West) describe, under this title, a form of disease which they 
deem identical with the continued fever of adults. Drs. Stewart 
and Condie, of this country, authors of works on the diseases of 
children, which are extensively read, regard the affection as 
symptomatic of intestinal irritation or inflammation. Dr. Smith 
has treated many cases both in private and dispensary practice, 
and has been led to form an opinion of the pathology of the dis- 
ease differing from the views of the writers just referred to. The 
cases which he has studied occurred in the upper wards of the 
city of New York, which, as he states, are in an eminently mala- 
rious situation. He regards the disease as in a large proportion 
of cases miasmatic. He gives the following facts in support of 
this opinion : — 

" 1. The disease is very prevalent in spring and autumn, and 
rare in mid-summer and mid-winter, like malarious affections. 

K. 8. — VOL. XIV. NO. IV. 1 1 



244 Report on Practical Medicine. [April, 

There are certain streets where I have known it to prevail 
almost like an epidemic in the vernal and autumnal months. If 
the disease were, as Dr. Condie states, 'in every instance, either 
a gastro-enteritis, an ileitis, or an entero-colitis,' how can this 
influence of the seasons be explained? 

" 2. Often, not always, the remissions are more marked than 
would be likely to occur in a symptomatic fever. The child 
may appear almost well in the morning, but in the afternoon 
and evening exhibit such intensity of symptoms as to cause the 
greater anxiety on the part of the friends. 

"3.. The symptoms are not altogether such as we should ex- 
pect to find in a purely local affection. The patient will, it is 
true, when asked where he feels the pain, sometimes place his 
hand on the abdomen, and pressure upon the abdominal parietes 
not unfrequently produces great distress. Dr. Condie alludes 
to this tenderness, evidently believing it to be a symptom of 
inflammation. But I have always been satisfied that it was 
neuralgic, from the fact that pressure on the lumber vertebrae, 
and frequently on the chest and limbs, caused as much suffering 
as when it was made on the abdominal walls. The patient, if 
old enough, will complain, too, of aching in the head, back, and 
limbs, which is more the symptom of an independent fever than 
of inflammation. 

" Again, constipation is ordinarily present, unless in the last 
stages of the disease. Intestinal irritation or inflammation, suf- 
ficient to cause so intense and protracted a fever as is often 
present, would be more likely to cause diarrhoea. 

" 4. Children, even nursing infants, take intermittent fever ; 
why, then, may they not take remittent fever, from malaria? 
In my class at the dispensary, children with these diseases are 
frequently brought in together. 

"5. I have found that measures directed' to the alimentary 
canal, beyond simple purgation, do more harm than good. They 
fail to ameliorate symptoms ; they awaken and distress the child. 
Moreover, when remissions occur, quinine will materially 
abridge the disease. 

" 6. Death seldom occurs from this affection. In one or two 
fatal cases which have fallen under my observation, this result 
followed convulsions and coma; and Dr. Stewart remarks, ' Dis- 
sections have furnished but little light on the morbid condition 
of the system in remittent fever; for on a fatal termination, the 
transmission to the brain is the ordinary course of the disease.' 
The mode of death, then, and the post-mortem appearances, do 
not comport with the doctrine that the intestines are the seat of 
the morbid process. 

"Dr. Condie does not agree with Dr. Stewart, but attributes 
death to inflammation of the intestines. I do not think that the 



1858.] Report on Practical Medicine. 245 

remittent fever which I have treated, if uncomplicated, ever ter- 
minates in this way, for I have never seen a case in which ab- 
dominal symptoms did not yield to simple measures. 

" 7. Continued fever of the adult is of rare, and infantile re- 
mittent of frequent occurrence in the locality of my practice. 
The latter is not then identical with the former, as it appears to 
be in London and Paris, from the descriptions given by Rilliet, 
Barthez, and West. 

"The above facts appear to me conclusive that the form of 
infantile remittent fever, which it has been my lot to treat, has 
been generally of a miasmatic character. 

" It is very important to understand the nature of this affection, 
as the treatment will vary according to the theory we adopt. If 
living in a malarious region, we embrace the Broussian views 
of the American authors whom I have cited, and treat the fever 
as a local disease, we shall fail to ameliorate the symptoms, and 
be mortified and discouraged by the result, if I may judge from 
my own experience. My reliance at present is mainly on ex- 
pectant measures, till remissions occur, and then on the exhibi- 
tion of quinine. In cases thus managed, convalescence has been 
more speedy and certain than when opium, calomel, and counter- 
irritation have been employed to remove intestinal irritation or 
inflammation. 

" At the risk of appearing presumptuous, I have thus present- 
ed a theory of infantile remittent fever not, indeed, novel, — for 
Taylor attributes one variety of it to miasm, but different from 
that contained in any American and most European treatises on 
diseases of children. I am the more anxious that the true nature 
of the disease should be understood, because I believe that the 
accepted doctrine is exceedingly pernicious to practitioners in 
malarious regions, and especially to the younger members of the 
profession who rely more on books than experience for guidance. 
The fact, too, that remittent fever has been in my practice the 
most frequent affection of early life, in the vernal and autumnal 
seasons, gives additional interest to the subject." — [New York 
Jour, of Medicine, Jan. 1857, p. 106. 



On the Different Methods of Treating Intermittent Fever, with the 
Results of Treatment in Sixty-nine Cases. By Austin W. 
Nichols, M. D., of Buffalo. 

The object in this paper is to study the effect of treating cases 
of intermittent fever without resorting to the preparatory treat- 
ment by emetics, cathartics, etc., which are still deemed impor- 
tant by many practitioners ; and also to institute a comparison 
as regards relapses and the duration of the disease, between a 



246 Report on Practical Medicine. [April, 

section of country where the disease prevails to a great extent 
every year, and a region not malarious. 

Of the 69 cases, 46 were treated in a malarious section, and 
23 in a region not malarious. 

Of the 46 cases occurring in a malarious section, 17 were treat- 
ed at once with quinia, in doses sufficient to arrest speedily the 
paroxysms, and 29 received preparatory treatment — viz. ipecac- 
uanha and calomel, or calomel combined with either rhubarb or 
jalap. Relapses were observed in 14 of the latter and in 4 of 
the former cases, the ratio being as 1 to 4| in the cases which 
did not receive, and 1 to 2^ in the cases which received the 
preparatory treatment. The average duration of the disease, 
dating from the commencement of the use of quinia, was found 
to be less in the cases which did not receive preparatory treat- 
ment, being a fraction over six days; while in the cases which 
received preparatory treatment, the average duration was a frac- 
tion under eight days. Adding the period occupied by the 
preparatory treatment, the r^tio is as 6£ to 8£ days. 

Of the 23 cases occurring in a region not malarious, all had 
no preparatory treatment. Of these cases, in ten, previous at- 
tacks had occurred. In the latter, the average duration of the 
disease, after treatment was commenced, was 3| days. In ten of 
the recent cases, the average duration was 2£ days. Of the 
latter, relapses were observed in two cases ; of the former in 
three cases. 

Comparing the results as regards duration and relapses in the 
cases occurring in the malarious section and not receiving pre- 
paratory treatment, and in the cases occurring in the region not 
malarious, the contrast is striking : the average duration in the 
former being 6j days, and the average of relapses 1 in 4± ; in 
the latter, 2} J days, and the average of relapses 1 in 3| cases. 
These results are greatly in favor of the region not malarious. 

The reporter analyses his collection of cases with reference to 
the types of the disease ; the number of paroxysms in each type ; 
the number of relapses and the duration in each type. He also 
analyses separately the cases of tertian type. 

The following summary embodies the practical conclusions 
which he deduces from the results of his analytical investiga- 
tion : — 

"From the foregoing analysis it will be seen that in cases of 
first attack the duration is somewhat less, and the number of 
cases relapsing about one-half that in cases having had one or 
more prior attacks. In a section of country where this fever 
is prevalent to a great degree every year, or in a malarious region, 
the duration is nearly three times that in a country not malari- 
ous, and the relapsing cases occur as frequently even under the 
same plan of treatment. It will be found that in a malarious 



1858.] Report on Practical Medicine. 247 

region the treatment of patients by quinia alone not only dimin- 
ishes the number of paroxysms and abridges the duration of the 
disease, but that fewer relapsing cases occur than where a pre- 
paratory course of treatment has been adopted. Even in the 
analysis of 40 tertian cases, although the duration of the number 
of paroxysms is nearly the same under the two different methods 
of treatment employed, yet the cases of relapse are found to be 
nearly twice as numerous where the preparatory plan was adopt- 
ed"— {Buffalo Med. Journal and Month 1 y Review of Medical and 
Surgical Science, January, p. 460.) 



Treatment of Remittent Fever. By Jxo. Herbert Clairboxe, 
A. M., M. D., Petersburg, Virginia. 

The practice of Dr. Clairbone, in cases of remittent fever, is 
embraced in the following quotations from an article entitled 
" Periodic vs Typhoid Fever." 

" It is in the treatment of these cases the ' triple base' of Mail- 
lot so accurately expresses the indications to be fulfilled— r-viz. 
1 To combat the visceral lesions ; to oppose the return of the 
paroxysms; to prevent the occurrence of relapses.' To carry 
out the first, it may be only necessary, if the patient be seen in 
the paroxysm, to administer six or eight grains of the mild 
chloride of mercury, with as many of Dover's powder, and one 
or two of ipecac, applying a dozen or two leeches to the head or 
stomach, according to the force of the reaction and its concen- 
tration at either point. The early occurrence of the remission 
will afford opportunity to exhibit the anti-periodic, which will 
effectually meet the two latter. Fifteen or twenty grains of the 
sulphate of quinine given in one dose at this time, or in two 
doses of a few hours' interval, will usually cut short an attack. 
Indeed, I have seen it succeed, in summarily effecting this end, 
after the disease had already continued unabated for more than 
a week, and when a dry tongue, nervous tremors, and incohe- 
rency of language had apparently ushered in the typhoid stage. 
After two or three days of treatment, if the fever still continue, 
which is sometimes the case, we have found smaller doses of 
quinine, five or six grains, exhibited in the remission, to answer 
a very good effect — gradually neutralizing the poison of the 
disease, and hastening convalescence, without inducing any of 
the disagreeable symptoms of cinchonism. We sometimes com- 
bine the quinine with calomel, ipecac, and opium, at its first 
administration ; and where there is much visceral engorgement, 
the antiperiodic is often thus more effectual. 

"Cases subjected to this treatment in their early stages have 
not generally, in our experience, { run into typhoid fever.' Of 



248 Report on Practical Medicine. [April, 

nineteen cases, not selected, but transcribed from our note-book 
of last September, the average duration of treatment was six 
days. Six more days would cover the average period of con- 
valescence. * * * * * 

" When the fever has persisted for one or two weeks, in spite 
of the treatment adopted, and the tongue begins to be dry, and 
brown, and fissured, and the bowels are irritable, we usually 
recommend, about once in twenty-four hours, four or five grains 
of Dover's powder, with as much of hyd. c. creta, if there should 
be a necessity for the latter in the condition of the secretions, 
and apply at the same time a mild visicatory over the abdomen. 
We continue the use of the antiperiodic, however, exhibiting 
three grains of quinine or an ounce of the infusion of cinchona 
and serpentaria every six hours, alternating sometimes with 
fifteen or twenty drops of oil of turpentine. 

" With regard to the use of purgatives. We have found them 
generally not only unnecessary, but positively prejudicial at any 
stage of the disease, and evincing, even the mildest of them, 
aptness to induce irritation of the bowels." 



Treatment of Scarlatina. By James D. Harper, M. D., Minden, 
Louisiana. 

After describing briefly the characters of an epidemic of scar- 
latina which prevailed in Minden in May, 1856, Dr. Harper 
gives the following account of his method of treatment, and the 
results. 

"Of the 40 cases under my care during the epidemic, there 
were 19 of simplex, 12 of mild anginosa, and 9 aggravated cases 
of anginosa, some of which threatened to assume the malignant 
form. In some of the cases, seldom anything was employed 
beyond a saline laxative, repeated from time to time, as circum- 
stances demanded. When the arterial excitement was very high, 
cold water to the head and throat, cooling drinks, and gargles of 
flaxseed and vinegar, constituted the treatment in a majority of 
the simple cases ; in others, the chlorate of potash was added to 
the treatment, as recommended by Dr. Watson, with the hap- 
piest effect. The twelve mild cases of anginosa yielded pretty 
much to the same treatment as those of the simple form, — the 
more lavish use of cold water, and the occasional application of 
nitrate of silver or sulphate of copper, with the probang, con- 
stituting the essential difference in the treatment of these two 
forms of scarlatina. The troublesome itching of the skin, which 
is apt to supervene upon the appearance of the eruption, can be 
relieved to some extent by sponging the surface with cold water, 
which does away with the intolerable heat ; brans of different 



1858.] Beport on Practical Medicine. 249 

kinds may be rubbed upon the body, and thrown into the bed 
of the patient, which soothes for a time. 

41 The nine cases, alarming in their character, underwent in the 
early stages, to a certain extent, the same treatment as those of 
the mild form ; but as they advanced, the more threatening be- 
come the symptoms, such as great difficulty of breathing, from 
glandular enlargement, combined with a viscid and tenacious 
secretion, choking up the larynx ; a more frequent pulse ; ex- 
treme restlessness and jactitation, doubtless arising from obstruc- 
tion in the air-passages, with some disposition to diarrhoea, and 
evident tendency to congestion of the brain ; in some, these 
symptoms were recognized at an early period ; in others, were 
deferred until desquamation had commenced. The head and 
throat trouble was the distinguishing feature in these cases; pulse 
ranged from 125 to 180, with more than usual heat about the 
head, attended at times also by slight incoherency, and nervous 
twitchings of the fingers and eyelids. There is but little doubt 
that in most of these cases the excitement of the brain evidently 
arose from the condition of the throat; these symptoms were, 
however, promptly met, not by sponging, but by pouring cold 
water out of a pitcher, or some other convenient vessel, upon the 
head, giving the water a fall of from 4 to 12 inches ; this was 
continued from 15 to 40 minutes at a time, or until the pulse 
was reduced 20 or 30 beats in a minute, and the head became 
cool. At this crisis, the patient would more frequently than 
otherwise go off in a refreshing sleep, lasting half an hour, more 
or less. Reaction manifested itself by the same restlessness, in- 
coherency, and hurried respiration, but which would always give 
way to the impression of the water, thereby placing the patient 
in a condition highly favorable for recovery, other things being 
equal. In some of the cases chlorine was used as a stimulant 
and antiseptic with good effect. 

"There was a condition of the throat which gave rise to much 
trouble, even after desquamation had in some instances almost 
subsided, and the patient otherwise convalescing; it was where 
the ulcer was so low as to be beyond the reach of the probang, 
and the little patient, not knowing the importance of raising the 
foul secretions, swallowed them, whereby the s}'stem became 
thoroughly inoculated with the animal poison, generating that 
condition of system well known as typhoid, and in one instance 
producing, as I am well convinced, that characteristic feature of 
the diseased state of the glands of Peyer, similar to that which 
accompanies genuine enteric fever, with a pulse from 125 to 180, 
a tympanitic abdomen, and considerable excitement about the 
brain. Cases of this character were treated pretty much as those 
of enteric fever, at the stage where similar symptoms were 
present, with the addition of cauterizing the ulcer of the throat, 



250 Report on Practical Medicine. [April, 

if accessible, which is most certainly the source of the mischief. 
A nourishing diet was given, also brandy or port wine, with a 
free use of chlorine, to rid, as much as possible, the secretions of 
their obnoxious properties. When the respiration became em- 
barrassed or hurried, from flatulency, turpentine was adminis- 
tered ; if any threatening of brain disease appeared, the patient 
was subjected to the cold water, and continued until such symp- 
toms were allayed. 

" This condition of things lasted from six to ten days. The 
motions from the bowels consisted mostly of secretions from the- 
throat, occasionally tinged with faecal matter ; but so long as the 
throat remained in an ulcerated state, diarrhoea was invariably 
present; it could only be temporarily checked, as the source of 
the malady had to be reached before any permanent benefit 
could be realized, proving that the diseased throat and enteric 
symptoms bore the relation of cause and effect. 

"The sequelae of ' scarlet fever' are generally a source of much 
interest and uneasiness to the physician. Indeed, there is no 
one disease which presents a longer catalogue of secondary affec- 
tions than scarlatina. Of the various diseases which are likely 
to follow scarlet fever, dropsy in some form is, according to my 
observation, the most frequent. Of the various forms of dropsy, 
anasarca is probably the one generally met with; it ordinarily 
makes its appearance from the last stages of desquamation to 
the third or fourth week following. Medical opinion is yet un- 
settled as to the form of scarlatina most apt to be succeeded by 
dropsy. Of the fifty-six cases enumerated, there were eight 
cases of anasarca, all of which supervened upon mild cases of 
scarlet fever, not one severe case of scarlatina resulting in dropsy 
of any kind. In the dropsies following this eruptive fever there 
is an almost total inaction of the kidneys, an inertness which 
seldom attends the disease originating from a different cause ; 
it readily yields to active hydragogue cathartics and diuretics 
— the one to produce copious watery evacuations from the 
bowels, while the other incites the kidneys to increased action. 
An exclusive milk diet should be rigidly adhered to throughout 
the complaint. When the lower extremities are swollen to any 
great extent, a bandage applied, beginning at the toes and ter- 
minating at the knee, or high up the thigh, if preferred, has been 
found highly useful in reducing the effusion. After the effusion 
has been in a great measure removed, if the patient is perceived 
to be in an anaemic condition, some one of the mineral acids, or 
ferruginous preparations, should be immediately resorted to. 
A varied and nutritious diet, in this state of the system, is ad- 
missible. 

" It is stated that the dropsies which follow scarlatina are some- 
times dependent upon, or associated with, that peculiar uraemic 



1858.] Report on Practical Medicine. 251 

state known as 'Bright's Disease;' if so, then a case thus de- 
pendent on, or associated with ' Bright's Disease,' would be 
found more difficult of cure than those which came under my 
notice. 

"Various speculations have been indulged in regard to the 
prophylactic virtues of atropa belladonna in scarlatina. There 
are few who place implicit reliance in its preventive properties ; 
others, again, firmly believe that it has the unmistakable power 
of modifying, if not preventing, an attack ; while others, whose 
statements are equally reliable, denounce its virtue in prevent- 
ing or modifying the disease, and, in this respect, as worthy 
only of the source from which it emanated. 

" I gave belladonna, during the epidemic of 1856, to 20 child- 
ren ; 19 of them took it as directed, and one irregularly. Of the 
20 children, the one only who neglected to take the medicine 
as directed had the disease ; most of the 19 who escaped were 
not only exposed to the epidemic influence, but to direct conta- 
gion. 

11 With this experience, I have ranked myself with that class 
of the profession who, without relying implicitly on the preven- 
tive powers of belladonna, yet deem it highly useful in modify- 
ing and arresting, to some extent, the dreadful ravages of scar- 
latina." — {New Orleans Medical and Surgical Journal, May, 1857, 
pp. 743—746.)* 



Hospital Treatment of Yellow Fever in New Orleans. By E. D. 
Powell, M. D., Brunswick Co., Ya. 

Dr. Powell states that, having been a resident of the Charity 
Hospital in New Orleans in 1855, he had an opportunity of 
comparing different methods of treating yellow fever, and the 
plan which appeared to him most successful was the following : 
A hot mustard foot-bath was promptly employed. Next, the 
infusion of orange-leaves given freely as a drink, and continued 
during the attack. As a purgative, castor oil combined with a 
few drops of laudanum. This was administered soon after the 
admission of the patient. Ice applied to the head to relieve cere- 
bral symptoms, if the later supervened ; also, local blood-letting, 
by cupping or leeching. — ( Virginia Medical Journal, June, 1857, 
p. 470.) 



* An interesting article by Dr. Lutton, of Aurora, Indiana, on the diversity of 
symptoms in scarlatina maligna having already appeared in the pages of this 
journal, (North American Medico-Chirurg. Review,) No. for Nov., p. 912, is not 
here introduced. 



252 Report on Practical Medicine. [April, 

Epidemic Fever characterized by mild Erythematic Pharyngitis. 

During the months of January, February, and March, 1857, 
there prevailed, in the city of Buffalo and its vicinity, a form of 
fever accompanied by mild pharyngitis, having a career of from 
three to five days, and generally, if not invariably, ending in 
convalescence. In a report made to the Buffalo Medical Asso- 
ciation by the reviewer, the results of an analysis of twenty-three 
recorded cases coming under his own observation were given, 
and the question of the identity of the disease with scarlatina, 
discussed. From the results of the analysis, the following de- 
ductions were drawn by the reporter: — "The disease was an 
epidemic fever, characterized by mild erythematic inflammation 
of the fauces as a constant local complication. Its character as 
esentially a fever is established by the febrile movement being 
in so marked a degree out of proportion to the local affection ; 
in other words, evidently not being symptomatic of the latter, 
and by its running a definite although a brief career. It is a 
fever of from three to seven days' duration. Its epidemic char- 
acter is sufficiently apparent. It has prevailed more or less ex- 
tensively in the city for about two months, reaching its acme 
gradually, declining gradually, and at length disappearing, af- 
fecting both sexes and different ages without notable discrimi- 
nation. As an epidemic fever its symptomatic features were 
very uniform. The erythematous affection of the fauces consti- 
tutes the only positive character, aside from the brief duration 
of the febrile career. The other symptoms uniformly present 
were only those incident to febrile movement ; and the symp- 
toms observed in a few cases — viz. the convulsions in one case, 
the retraction of the head in one case, etc., were only incidental 
events, not intrinsic elements of the disease. The small patches 
of white exudation observed in some of the cases do not suffice 
to establish any relation of the local affection to that called diph- 
theritic by Brettonneau and others. The occurrence of several 
cases repeatedly in the same family does not suffice to prove 
that the disease was propagated by contagion, since this fact is 
explicable on the supposition of the patients being equally ex- 
posed to an epidemic influence, and there being a marked dis- 
crepancy in the intervals separating the cases necessarily occur- 
ring in the same family. 

The disease was considered as a species of fever distinct from 
scarlatina, on the following grounds : 1. The uniform absence 
of the scarlatinous eruption on the exterior surface. 2. The 
uniform absence of any connection with well-marked cases of 
scarlatina, occurring either previously or subsequently. In no 
instance was the disease preceded or followed by scarlatina in 
the same family. 3. Several of the persons affected being adults 



1853.] Liability of Xegroes to Epidemic Diseases. 253 

and persons beyond middle life. 4. Medicine was in no in- 
stance followed by the sequels of scarlatina — viz. rheumatism, 
serous inflammation, and especially dropsy. 5. In several in- 
stances the persons affected had had scarlatina. 

Professor Eochester at the same time made a report on the 
same subject. Between January 6th and April 4th he had noted 
thirty-seven cases. In many instances he had been led to ob- 
serve irregular intimacy in the febrile movement. The subjects 
in ten cases were of all ages and conditions. He regards the 
communicability of the disease as probable. If communicable, 
the period of incubation is short, the disease manifesting itself 
in some instances within twenty-four hours after exposure. In 
many of his cases the patients had had scarlatina. Two children 
who were very ill with scarlatina had this form of fever a month 
after their recovery. — (Buffalo Med. Journal, May, p. 718.) 



Liability of Xegroes to the Epidemic Diseases of the Soutli. 

The fact is so glaring, and so universally admitted, that I am 
really at a loss to select evidence to show that there is no accli- 
mation against the endemic fevers of our rural districts. Is it 
not the constant theme of the population of the South, how they 
can preserve health ? and do not all prudent persons, who can 
afford to do so, remove in the summer to some salubrious local- 
ity, in the pine-lands or the mountains ? Those of the tenth 
generation are just as solicitous on the subject as those of the 
first. Books written at the Xorth talk much about acclimation 
at the South ; but we here never hear it alluded to out of the 
yellow-fever cities. On the contrary, we know that those who 
live from generation to generation in malarious districts become 
thoroughly poisoned, and exhibit the thousand Protean forms of 
disease which spring from this insidious poison. 

I have been the examining physician to several life-insurance 
companies for many years, and one of the questions now asked 
in many of the policies is, u Is the party acclimated?" If the 
subject lives in one of our southern seaports, where yellow fever 
prevails, and has been born and reared there, or has had an at- 
tack of yellow fever, I answer, '' Yes." If, on the other hand, 
he lives in the country, I answer, *'No;" because there is no ac- 
climation against intermittent and bilious fevers, and other 
marsh diseases. Now, I ask if there is an experienced and ob- 
serving physician at the South who will answer differently ? An 
attack of yellow fever does not protect against marsh fevers, nor 
vice versa. 

The acclimation of negroes, even, according to my observa- 



264 Substitute for Human Milk. [April, 

tion, has been put in too strong a light. Being originally natives 
of hot climates, they require no acclimation to temperature, are 
less liable to the more inflammatory forms of malarial fevers, and 
suffer infinitely less than whites from yellow fever : they never, 
however, as far as my observation extends, become proof against 
intermittents and their sequelae. The cotton planters throughout 
the South will bear witness, that, wherever the whites are at- 
tacked with intermittents, the blacks are also susceptible, though 
not in so great a degree. My observations apply to the region 
of country removed from the rice country. We shall see, fur- 
ther on, that the negroes of the rice-field region do undergo a 
higher degree of acclimation than those of the hilly lands of the 
interior. I know many plantations in the interior of Alabama, 
South Carolina, Georgia, Mississippi, and Louisiana, on which 
negroes of the second and third generation continue to suffer 
from these malarial diseases, and where gangs of negroes do not 
increase. (P. 376.) 

And again : Certainly, negroes do suffer greatly on many 
cotton plantations in the middle belt of the Southern States ; 
and I have seen no evidence to prove that negroes can, in this 
region, become accustomed to the marsh poison ; and my obser- 
vation has been extensive in four States. A question here 
arises : Is there any difference in types of those malarial fevers 
which originate in the flat tide-water rice-ilands, and those of 
the clay- hills, or marsh fevers of the interior? I am inclined to 
think there is. — Indigenous Races, p. 376; Art. "Acclimation," 
etc. By J. C. Nott, M. D., of Mobile, Ala. — [North American 
Medico- Chir. Review. 



On a Substitute for Human Milk. Bv William H Cummixg 
M.D. 

[The following, on a most important department of Hygiene, 
is from the pen of one, in whom we are gratified to recognize 
one of the alumni of the Medical College of Georgia. Dr. C. 
has devoted much attention to the subject of which he treats, 
and his views are reliable, for they are the result of the most 
intelligent personal observation and diligent experiment.] 

Artificial lactation is the subject of this paper. In order to 
prepare our minds for its proper consideration, it will be well to 
examine the natural function in its normal state. 

Lactation exists as a function only among the Mammalia. 
These derive their title as a class from the existence of the organs 



1858.] Substitute for Human Milk. 255 

of this function. "Whether they spend their lives in the water 
or on the land, whether they swim or creep, or walk or climb, 
or fly, they all have milk-producing organs; they all suckle 
their young. 

And yet there are foreshadowings of lactation far down the 
scale of being. The bees and wasps and ants prepare a supply 
of food for their young, and the larva on his emergence from the 
egg, finds this provision near at hand and amply sufficient for 
his wants. 

Many birds bring insects and worms to their yet unfledged 
young. The swallow and the wren are familiar examples of 
this. Nothing can exceed the diligence and assiduity with 
which they devote themselves to this important work of artifi- 
cial lactation. The pigeon comes still nearer to the mammalia 
in this matter, for it supplies to its young an abundance of part- 
ly digested food. The fact has not escaped notice, and "pigeon- 
milk " is the name of this article of diet. 

The truth is, that most animals leave the egg or the womb in 
a state of development in which they are unable to obtain and 
use the ordinary food of their kind. In most cases their or- 
gans of locomotion do not enable them to obtain this food. The 
larva of the bee cannot fly, the puppy cannot walk, the monkey 
cannot climb, the beaver cannot swim. Nor can they in most 
cases masticate and digest such food as their parents use. The 
teeth are ordinarily still within the gum, and do not appear for 
some time after birth. Most of these animals therefore abso- 
lutely require for their sustenance and growth a peculiar food 
suited to their actual condition. 

What then is lactation ? It is the secreting from their own blood, 
in organs then, and then only active, and the furnishing to their 
newborn young, a liquid food suited to the various degees of 
their development at birth, and the continuing to furnish the 
supply, until the young animal has become able to use the ordi- 
nary food of his race. 

This secretion is continued much longer in some animals than 
in others. The young are not born in the same state of develop- 
ment. The young of the Marsupials leave the womb while yet 
in an embryotic state. The ruminants stand at the other ex- 
treme. Between these the other orders range themselves. In 
order to fix this fact in our minds, let us compare those animals 
with which we are most familiar. Compare the rat, tlie puppy, 
the kitten, with the colt, the lamb, the calf. Blindness, weak- 
ness and deformity mark the former ; while the latter are able 
to see and hear and walk. How soon do the young ruminants 
follow their dams, skipping and running as they go. The states 
of development at birth are thus seen to vary greatly. 

The nature of the future food of the young animal has an im- 



256 Substitute for Human Milk. [April, 

portant connection with the length of lactation. The digestion 
of grass and grain and roots requires more gastric energy than 
that of worms and insects and flesh. In conformity with this, 
is the fact, that the graminivorous animals furnish milk to their 
young until the latter are very much more developed than the 
carnivora are when they are weaned. 

We have used the word Milk. What is Milk ? It is a gen- 
eral term for the various products of the mammary glands of 
different animals. It is the name for the food furnished by these 
mothers to their young. Milk is a white, obaque, oily liquid, 
its color is not pure white, but verging on yellow. In some 
animals it is sweet, containing notable quantities of sugar. But 
in all it contains three great constituents — butter, cheese and 
water. 

We have said that milk is suited to the wants of the young 
animal. It consists universally of two classes of food; oily 
materials containing no azote, and caseous substances holding 
in combination mineral salts, and admirably adapted to the 
growth of the body. 

It is suited to the wants of the young animal. What is the 
first want of a new-born animal of this class? Warmth. He 
has been, during the previous stages of his existence, surround- 
ed by tissues of the temperature of 100°. He is now out in 
the open air f or in still colder water, the heat of his body rapidly 
radiated or conducted into these cooler media. This loss of heat 
does not lower his temperature, for there is an internal supply. 
At the moment of his birth, respiration commenced, and the 
oxygen of the air combining with the oil of his body, evolves 
heat sufficient to replace that which is lost. But this consump- 
tion of oil cannot be long continued, unless the supply be re- 
newed. The body will be soon reduced to a state of extreme 
emaciation, and death from cold must follow. 

A supply of oil is then the first want of the young animal. 
The lamp of life must be fed, or it will speedily go out. The 
milk contains oil in proper proportion for this purpose. This 
oil is butter. 

But not only must the vital heat be maintained, the tissues of 
the child must grow. The materials for the growth of the tissue 
are supplied by the casein or albuminous portion of the milk. 
The name casein is applied to a group of substances having an 
almost identical chemical composition. Indeed it has until re- 
cently been supposed to be identical. But it has been ascertain- 
ed by Quevenne, that while their organic composition seems the 
same, they hold in combination different proportions of mineral 
insoluble salts. Thus, phosphate of lime (the bone earth) exists 
in different proportions in suspended casein, in dissolved casein, 
in albumen, and albuminose. These four substances also differ 



1858.] Substitute for Human Milk. 257 

in the effects produced upon them by different agents. Thus, 
while suspended casein is coagulated by a small quantity of ren- 
net, the dissolved casein, the albumen, and the albuminose are 
unaffected by it. Thus, while the albumen is coagulated by 
ebullition of the milk, the other three constituents of the casein 
are unaffected. Xitric acid produces the same effect without 
the agency of heat. 

-In the present state of our knowledge on this subject, we can 
only say that these four substances, by the action of the gastric 
juice, seem to be all converted into albuminose, and to be in this 
form absorbed into the system. 

Thus constituted, having both azotised andunazotised elements 
the milk is suited to supply the wants of the animal, and to pro- 
mote his growth and development. 

These general statements concerning lactation are applicable 
to the function as existing in the woman. An element which 
is not universally but very generally found in milk, exists in 
human milk in the proportion of 0.075, we refer to the sugar. 
Of the uses of the sugar we are not so well informed. There is 
reason to believe that it contributes principally to the mainte- 
nance of the heat of the body. 

AVe come now to the subject of artificial lactation. Some- 
times by the death of the mother, more frequently by her fail- 
ure to secrete enough milk, the child is deprived of the needed 
supply. Something must be done for the famishing infant. In 
a few cases, we may have recourse to another woman for the 
needed food. Few good nurses, however, can be found. In 
the cities, there are by no means enough to supply the demand 
for human milk ; in the country, they can scarcely ever be ob- 
tained. In this country we can find no permanent, reliable sup- 
ply of milk, except that furnished by the cow. The question 
is, — Can artificial lactation be successfully performed by means of 
the milk of the cow? This is a question of great interest to 
medical practitioners, as well as to parents. 

In using cow's milk as a substitute for the natural food of in- 
fants, great difficulties are found. These arise from the differ- 
ence of composition of the two kinds of milk — thus : 

{Butter, 38.59 C Butter, 20.76 

Casein, 40.75 While Hwnan Milk is J Casein, 14.34 

Sugar, 53.97 composed af 1 Sugar, 75.02 

Water, 866.69 ^ Water, 889.88 

If we so dilute cow's milk as to reduce the butter to 20.76, we 
shall have 21.92 of casein, or 50 per cent, more than in human 
milk. This excess of casein leads to serious indigestion, with 
consequent gastric and intestinal disorders. 

If, on the other hand, we reduce by still farther dilution the 
casein to 14.34, we shall have only 13.58 of butter, or less than 



258 Substitute for Human Milk. [April, 

two-thirds of the proper proportion. This deficiency of butter 
does not produce such immediate disturbance as we have stated 
to follow the excess of casein, but its permanent influence is 
most injurious. 

First, because there is a deficiency of the material needed for 
the production of heat. If the temperature of the body be 
lowered, all the functions languish, and the child is unable to 
resist the hurtful influence of atmospheric changes. 

Secondly, this deficiency of butter implies a corresponding 
deficiency of the phosphureted oil (lecithine) of the milk, the 
proper and peculiar nutriment of the nervous system, which ex- 
ists in butter in the proportion of 8 per cent, or one-twelfth. If 
there be a deficiency of one- third of the butter, there will be of 
necessity, a corresponding deficiency of one-third of this phos- 
phureted oil. As the child, during the first year of his life, 
should take from 1,000 to 1,400 lbs. of milk containing from 20. 
76 to 29.06 lbs. of butter, the annual deficiency of this phosphu- 
reted oil would be from 0.5536 to 0.7749 lb.; that is, from nine 
to twelve ounces. The natural consequence of this deficiency of 
nerve food is failure of nervous energy, and imperfect performance 
of nerve functions. The various processes languish, and calori- 
fication, circulation, absorption, digestion and secretion all feel 
the depression. 

The proper remedy for these evils, is to provide a milk much 
richer in butter than the ordinary milk of the cow. If we leave 
a quantity of cow's milk at rest for four or five hours, and then 
carefully remove and examine the upper third, we find that it 
contains about 50 per cent, more butter than at first. In round 
numbers, the butter is to the casein as 57 to 40, or as 100 to 70. 
Now this is the relation between these two substances in human 
milk. If we then so dilute this new milk as to reduce the casein 
to 14.34 thousandths, we shall have 20.76 thousandths of butter. 
This is just what we need (with the addition of sugar) as an 
accurate imitation of human milk, and, therefore, a good substi- 
tute for it. 

Take, then, ordinary cow's milk and let it stand for four or 
five hours. For a child three months old, 2 \ quarts will be 
needed. Take the upper third, (l£ pints,) and add to it 2 \ pints 
of water; sweeten it with the best sugar, of which 2| ounces 
will be required. It should be made somewhat sweeter to the 
taste than ordinary cow's milk. 

A child three month old will take from 48 to 60 fluid ounces, 
daily, in six or seven doses of a half pint each. 

It should be given from a bottle — suction being the only proper 
mode of feeding for a young child. 

Its temperature should be from 100° to 104°. It should be 
warmed again if it becomes cool while the child is taking it. 






1853.] Substitute for Human Milk. 259 

The child should be early trained to pass 6 or 8 hours at night 
without feeding. 

The kind of bottle, which for cheapness and convenience is 
most advantageous, is a plain 8 ounce vial, of an elliptical form. 
The artificial nipple is best made by rolling a quill in soft mus- 
lin and forcing this into the neck of the vial, leaving about three 
fourths of an inch projecting from the neck. The ease with 
which the muslin may be unrolled and thoroughly washed, gives 
this arrangement a superiority over every other, especially in 
warm weather. The quill also may be readily cleaned. 

The child should be fed at intervals of three or three and a 
half hours. [Regularity in this respect is very advantageous. 

During the first month, the child needs food of different com- 
position. There should be more butter in proportion to the 
casein. In order to obtain this increased proportion of butter, 
let the upper eighth of the milk be taken instead of the upper 
third. This milk contains from 70 to 80 thousandths of butter. 
It should be diluted with 2.6 parts of water. 



For a 


child from 3 to 10 days 


old. 


Milk 1000 


Water 2643 


Sugar 


243 


" 


•* 


10 to 30 


<< 


" 


<( 


2500 


(< 


225 


u 


<< 


1 month old. 




" 


" 


2250 


" 


204 


it 


<t 


2 




K 


" 


1850 


" 


172 


tl 


<« 


3 




it 


tt 


1500 


<« 


144 


<< 


" 


4 




it 


it 


1250 


ti 


124 


It 

tl 


i. 


5 
6 




tl 


a 


1000 
875 


it 


104 
94 


II 


" 


7 




tl 


" 


750 


" 


84 


II 


" 


9 




tt 


it 


675 


f 


78 


If 


n 


11 




tl 


" 


625 


tt 


73 


if 


tt 


14 
18 




it 


tt 
it 


550 
500 


ti 


67 
63 



By thus gradually diminishing the proportion of water, we 
furnish the child a milk containing an ever-increasing propor- 
tion of nutritive matter. 

How long should artificial lactation be continued ? The only 
answer to this is, " until the child has become able to use ordina- 
ry human food." The child should be fed with milk until his 
organs of mastication and his powers of digestion render it best 
for him to have other food. And at what age does this condi- 
tion exist ? Children vary so much in the rate of their devel- 
opement, that no answer can be given applicable to all cases. 
In a vigorous child the first dentition is usually completed at 
two years of age. Sometimes this appearance of the full com- 
plement of teeth takes place six months earlier, and sometimes 
six months later. Whenever this first dentition is completed, 
the child has the full masticating apparatus of childhood, and 
may receive other food than milk. In many cases, lactation 
must be continued until the age of three years. And it may be 
safely presumed, that no food will be found so suitable for the 
11* 



260 Substitute for Human Milk. [April, 

tardily-developed child as that which divine wisdom has prepar- 
ed for the purpose of promoting this development. As an 
article of food for adults, milk is of great value. Entire races 
of men rely upon it, and it seems, when thus largely and per- 
manently used, to promote strength and vigor. For the forma- 
tion of teeth and bones, its phosphate of lime is indispensable, 
and no other food suited to a feeble child contains so much in 
intimate union with organic elements. 

Nothing has been said of any other mode of artificial lacta- 
tion. This omission is not accidental. The truth is, that milk 
is the only material that inspires or even warrants any hope of 
real success. But this is not meant to say that all children reared 
otherwise die, but that good, physiologically good results do 
not follow the use of any other food. Children may survive 
months of arrow-root or other farinaceous food, but a normal, 
healthy, happy, vigorous, steady, ever-advancing development 
was never yet attained in this way. The human stomach has 
no creative power. The materials must be furnished, or the 
building cannot rise. Lecithine must be given, or the nervous 
energy declines. Without phosphate of lime, how shall the 
teeth and bones be made ? 

If we examine the constitution of the blood, we shall find 
what materials go to make the human body. What are these ? 
Oxygen, hydrogen, carbon, azote, chlorine, fluorine, iodine, 
sulphur, phosphorus, silicon, potassium, sodium, calcium, mag- 
nesium, iron and manganes. Of these sixteen substances, all 
are found in milk. And not only so, but they exist in the milk 
in the same combinations as in the blood. Not only have we 
chlorine and sodium, but we have chloride of sodium ; not 
merely phosphorus and calcium, but phosphate of lime already 
prepared for use. Not only have we oxygen and hydrogen and 
carbon, but we have ten different oils already existing in the 
milk. We have four different protein compounds, each holding 
in combination a definite proportion of phosphate of lime. Thus, 
and in all probability thus only, can this invaluable, but inso- 
luble salt be introduced into the tissues, and give strength and 
firmness to the frame. Why, then, with this evident adaptation 
of milk to the development of the body, should we look for 
other articles of food? Among all the substances now used, 
none can make any such claim. Indeed, it may be safely said, 
that milk is an article standing alone, prepared expressly for 
this one purpose, and challenging all competition. 

If the attempt made in this paper to show that the milk of the 
cow may be so modified as to suit the peculiar wants and condi- 
tion of the infant, has been at all successful, there is ground for 
hope that much'suffering may be relieved, and many lives saved. 
The subject is one of great importance, and demands the earnest 



1858.] Empyema Treated by Injections. 261 

consideration of the medical profession. To them the eyes of 
anxious and sorrowful parents are turned for help ; if aid can 
be given, let it not be withheld. — [American Med. Monthly. 



Empyema Treated by Injections. By David PsiNCK, M. D., of 

Jacksonville, 111. 

[The following case presents some analogy to the one reported 
in our last number, by Dr. Sternes DeWitt, of Baker county, 
Georgia. Dr. DeTTitt reports a definite and very large quanti- 
ty of pus. In this case the amount is not designated. 

Dr. De Witt treated his case successfully, by large injections of 
cold water into the cavity of the pleura, which we would much 
prefer to the use of Iodine injections, recommended in the fol- 
lowing report : — Edts.] 

The perusal of Dr. Brainard's case of cure of empyema of the 
pleural cavity by injections of iodine (A. II". M. and S. Jour, for 
November), has induced me to record a case of mv own in your 
valuable Journal. 

Little Henry Lurton, aged four years, the third child of heal- 
thy parents, and of healthy constitution himself, had an attack 
of pleuritis of the right side, and was left entirely to the aid of 
the vis medicatrix nature?, under the guise of infinitesimal doses 
for about six weeks, when, on the 2Sth of J;<nuarv, 1856, I was 
called upon for surgical interference. 

At this time the enlargement of the right side was very obvi- 
ous to the eye, and the sound was dull on percussion. 

Frequent and quick pulse and daily fever and nightly sweats 
were present, while the little patient could breathe only in the 
sitting posture, and his sleep was in the rocking chair. 

A considerable quantity of pus was discharged through the 
canula left in the orifice made by the trochar, giving immediate 
and inexpressible relief. 

Feb. 9th. — The puncture had not been kept open, and the 
demand for a second puncture became urgent. The amount dis- 
charged was somewhat smaller than before. The opening was 
from this time prevented from closing by the daily introduction 
of a tent, upon the withdrawing of which, a considerable quan- 
tity of ill-conditioned pus would be discharged. 

As nature seemed not to be making good progress with the 
case, it was resolved to see if the behaviour of iodine would be 
as good here as in other cavities. On the 25th of March, two 
drachms ( 3ij) of strong tincture of iodine were thrown in by a 



262 On the Escharotic Treatment of Cancer. [April 

small glass syringe. This was done after the tent had been with- 
drawn, and the pus collected during the preceding twenty-four 
hours had pretty well escaped ; the tent was again introduced as 
usual, to be daily withdrawn as before. 

The injection was repeated at intervals of about a week, for 
five times, when the discharge had pretty much ceased. The 
respiratory murmur could be heard throughout the whole ex- 
tent of the lung ; all sign of disease has disappeared, and by the 
middle of May the boy was at play with his top. — [Chicago Med. 
Journal. 



On the Escharotic Treatment of Cancer. By Professor Syme. 

After some sour comments upon Dr. Fell's mode of treating 
cancer, and upon the conduct of the surgeons of the Middlesex 
Hospital, in allowing so irregular an experiment to take place 
under their auspices, Mr. Syme proceeds to state his own opin- 
ion upon the escharotic treatment of cancer and to offer certain 
practical rules upon the treatment of cancer generally. 

"If," he says, "caustic is ever used for destroying malignant 
textures, it should, therefore, be of such power and so employed 
as to strike at once to the root of the evil, and I am able to sug- 
gest efficient means for this purpose. 

"Mons. Yelpeau, in speaking of the caustic made by mixing 
sulphuric acid with saffron, expresses his persuasion that it would 
be the best of all escharotics except for its expense and the diffi- 
culty of confining its action within certain limits. It occurred 
to me that sawdust would supply the place of saffron, and my 
assistants at the hospital ingeniously devised the following ef- 
fectual means of restraining the extent 4 of action. A solution 
of gutta percha in chloroform is applied to the skin for some 
distance around the part to be attacked ; then a thick piece of the 
same material, with an aperture cut in it of the requisite size, 
and softened by exposure to heat, is pressed firmly so as to ad- 
here everywhere to the surface thus prepared ; a thin piece is 
next glued round the edge of the opening, so that, when support- 
ed by a stuffing of lint, it may form a wall enclosing the diseased 
part. Concentrated sulphuric acid, with about an equal weight 
of sawdust stirred into it, until the admixture assumes a homo- 
geneoes consistence equal to that of thin porridge, is lastly ap- 
plied, in quantity proportioned to the extent of thickness con- 
cerned. In the first instance, as the pain is acute, opiates or 
chloroform may be used ; but after a short while, so little uneasi- 
ness is felt that the patient can easily allow the caustic to remain 
for ten or twelve hours, when it will be found that the whole 
diseased mass, though covered with skin and several inches in 



1858.] Syrup of the Superphosphate of Iron. 263 

depth, has been reduced to a cinder, presenting the appearance 
of strongly compressed tow. Under poultices, the slough sepa- 
rates in the course of days or weeks, according to its depth, and 
the sore then heals without any trouble. If, therefore, patients, 
from an unconquerable dread of cutting, should prefer the 
escharotic treatment, or if the circumstances, on any other ac- 
count, should seem to render this method eligible, the procedure 
just described may be found useful. 

11 In conclusion, I beg to offer the following principles or prac- 
tical rules for the treatment of cancer : — 

"1. The treatment of cancer may be divided into curative and 
palliative. 

11 2. The curative treatment should not be undertaken when 
the local disease is so seated or connected as to prevent its com- 
plete removal ; when the lymphatic glands are affected ; and 
when the patient's general health is deranged. 

"3. Removal may be accomplished by means of the knife, 
escharotics, and ligatures. 

" 4. Of these means, in general, the knife is best, and ligatures 
the worst. 

"4. Escharotics may be used with most advantage when the 
disease is superficial. 

" 6. Escharotics, employed with a curative view, should al- 
ways destroy the whole morbid part by one application. 

" 7. The palliative treatment is generally best accomplished 
by means of soothing applications and attention to the general 
health. 

11 8. When the local disease is very troublesome, it may some- 
times be relieved for a time by destruction of the morbid growth. 

"9. The best agent for this purpose, and also with a curative 
view, is concentrated sulphuric acid properly applied." — [Edin- 
burgh Med. Jour., and Banking's Abstract. 



Syrup of the Superphosphate of Iron. By Alexander Cush- 

MAN. 

The very favorably mention made in the European Medical 
Journals, of this new remedy induced some of our physicians to 
send out during the past year, and obtain a supply for the pur- 
pose of testing its effects. 

The result was so far satisfactory that many others wished to 
introduce it in their practice, and the English supply being ex- 
hausted, I found it necessary to prepare it myself, which I did 
according to the formula of Mr. Greenish, of London, as specified 
in the U. S. Dispensatory, under the article on Ferri Phosphati. 
A paper in the American Medical Gazette for January, also 



264 Syrup of the Superphosphate of Iron. [April, 

brought it more generally before the profession here, and it ap- 
pears to be attracting much attention wherever it is heard of. 
Hitherto the precipitated phosphate of iron has been but little 
employed owing to its repulsive color, but when as at present 
it is dissolved in an excess of phosphoric acid, and formed with 
sugar into a clear white syrup, as inviting to the eye as agreea- 
ble to the taste, there is reason to anticipate that its use will 
become very popular. 

A careful and somewhat troublesome manipulation is requisite 
in the preparation of this syrup, in order to produce a perfect 
result. There is a strong tendency to reaction between the sugar, 
and the acid, which will sometimes cause a precipitation of the 
iron, sometimes a granulation of the sugar, and sometimes a 
partial decomposition of the latter, resulting in a reddish or 
brown color, more or less dark. Experience and care in regula- 
ting the heat only will prevent these accidents. When however, 
once perfectly formed, there is no tendency to decomposition, as 
it is not affected by the atmosphere or by light, nor does it show 
any disposition to ferment. The variable quality of the phos- 
phoric acid of the shops, is also a fact to be guarded against. 
Out of twenty-three parcels which I have examined, only four 
have proved to be of standard strength. That this is no unusual 
case, may be seen by comparing the following analyses, showing 
the proportions of Anhydrous acid and water in the specimens 
examined by four different authors. 

Kose. Peligat. Dulong. Berthol. 

P.O. 92-7—90-52 .... 8745 .... 82-92 .... 75 
H.O. 7-3 — 948 .... 12-55 .... 17-08 .... 25 
If the acid used is not of sufficient strength to dissolve the 
phosphate of iron immediately, it forms an insoluble white com- 
pound, probably the tribasic phosphate which cannot be made 
use of. On the other hand, an over excess of acid renders the 
resulting syrup disagreeably sour, and of course gives an uncer- 
tainty to the preparation which should not exist, besides increas- 
ing the likelihood of decomposition in the sugar. Each new 
parcel of acid should therefore be tested before use, to determine 
the exact amount required to neutralize a given quantity of the 
precipitate phosphate, before proceeding to make up any large 
amount. 

It may not be amiss in this connection, to quote a few of the 
cases given under the authority of Greenish as showing the pe- 
culiar class of diseases in which the superphosphate of iron has 
been successfully administered in England. 

" Case 1. — A University Student, very weak, emaciated with 
loss of appetite, diarrhoea followed by obstinate constipation of 
frequent occurrence, palpitation of the heart, loss of memory, 



1858.] Syrup of the Superphosphate of Iron. 265 

countenance sallow, frequent headache, which would continue 
for hours, and quite incapacitate him from mental exertion. The 
syrup of the superphosphate of iron was prescribed three times 
a day. In about ten days he expressed himself to be an altered 
man; the headache had not recurred, his apetite improved, his 
strength was greatly increased — indeed, in about a month he 
was perfectly well, and was enabled to compete, and successful- 
ly so, for several prizes which in his former state would have 
been quite impossible. He has continued well ever since. 

" Case 2. — A young lady had for some time suffered greatly 
from painful and defective menstruation ; her general aspect was 
palid, with a marked green tinge. There was great pain and a 
sensation of sinking in the back with copious leucorrheal dis- 
charge, great headache, especially in the erect position or walk- 
ing. For these reasons, she was unwilling to exert herself; she 
complained much of languor, and it was said by those acquaint- 
ed with her, that of late she had become very dull of apprehen- 
sion ; she had no appetite, could not take animal food, and what 
she did take always laid heavy on her stomach ; constipation 
was always more or less present, except when she took power- 
ful purgatives, which very much weakened her. The syrup 
was prescribed in doses of a teaspoonful three times a day. In 
about a week she was much improved, and by the end of a 
month the menses recurred without pain, and in larger quantity 
than she had seen for weeks. From that time all her disagreea- 
ble symptoms had disappeared, and she has continued well ever 
since. 

" Case 3. — A young man, suffering from carious softening of 
one of the bones of the wrist, and who had been long under med- 
ical treatment, as a last resource was recommended to take the 
syrup of superphosphate of iron. He did so with the greatest 
success. The wrist was subsequently injured a second time in 
playing cricket, and the disease recurred ; he was again ordered 
to take the syrup of the superphosphate of iron, and the disease 
was again arrested, and the use of the wrist completely restored 
in a short time. 

" Case 4. — A child two years of age, was affected with weak 
ankles, and to such an extent, that his walking powers were 
materially interfered with ; his feet turned in and upon them- 
selves continually. The syrup was suggested and tried, and in 
the course of a very short time, the ancles appeared to have ac- 
quired much power, the child being enabled to walk perfectly, 
uprightly, and firmly, upon them ; the case indeed progressed 
to a perfect cure in about a month." 



266 Syrup of ilie Superphosphate of Iron. [April, 

These cases tend to establish the truth of the theory, that the 
waste of nervous energy and mental power occurring in many 
diseased states of the system, arises from a deficiency of phospho- 
rus and iron in the tissues of the brain and nerves, which this 
preparation is calculated to supply most promptly and adequate- 
ly, presenting those substances, as it does, in a state of chemical 
combination most easily assimilated by the blood. 

It is certainly known that iron and phosphorus are among 
the most important constituents of the body. 

" The brain consists essentially of phosphoric acid and oil, and 
a due proportion of the first is necessary to the integrity of the • 
mental functions. Iron exists in the blood as a phosphate, but 
the digestive powers are sometimes so weakened that they cannot as- 
similate other preparations of iron, and convert them into the phos- 
phate required. 11 " In some cases of weakness the amount of the 
phosphates excreted, is so much greater than that contained in 
the food taken, that the phosphates of the living tissues are preyed 
upon for a supply ', especially the brain, the richest in phosphorus 
of all the organs. Hence madness, loss of memory 1 and various 
other disorders of the mental organization." 

u As in tubercular disease the fatty tissues are preyed upon, 
and cod-liver oil, and other highly carbonized substances, have 
proved useful in supplying the waste, so there are cases where 
the superphosphate of iron may act in a similar manner, by giv- 
ing directly to the system the amount of phosphorus and iron 
necessary to prevent any injurious overdrain, and allowing time 
for recuperation by the natural forces." 

The proportions of the syrup used in the above case, as of 
that prepared by myself, are forty grains of the phosphate of 
iron to each fluid ounce of syrup. This gives the full dose of 
five grains of phosphate to the teaspoonful, or fluid drachm. Its 
effects, as I have been informed by several of the physicians who 
have already tried it, are remarkably prompt in this dose. For 
children it is sometimes diluted with two or three times its bulk 
of simple syrup flavored with orange flower water, or with gin- 
ger or some agreeable fruit syrup. All the bitter and astringent 
tinctures and infusions unite with it without decomposition, so 
far as I have tried them, so that tincture of cinchona, rhatany, 
&c, may be prescribed with it in any desired proportion. Add 
to these facts that it does not injure the teeth or blacken the 
stools, and it presents advantages simply as an eligible mode so 
administering iron, apart from the theoretical claims adduced 
above, which must give it a high place. — [Am. Druggists 1 Circular. 

[We feel much inclined to say here to our readers — "Bead 
this again." It certainly presents matters of weighty importance 
for our consideration. — Edts.] 



1858.] Abdominal Typhus of Children. 267 



On the Abdominal Typhus of Children. By Dr. Edmund Fried- 
rich, of Dresden. 

The following analysis of Dr. Freidrich's work on "Der 
Abdominal Typhus der Kinder," is from the pen of Dr. E. 
Noeggerath. 

u The author," writes the reviewer, "having been for some 
years house-physician in the hospital for sick children of Dres- 
den, Saxony, has made a collection of observations relating to 
typhus fever in children, which were taken partly from personal 
experience, partly from notes recorded in the day-books of the 
hospital. It comprises an analysis of 275 cases of typhus fever, 
occurring during twenty -one years, in a number of 14,868 chil- 
dren, which makes 1 out of 54, and speaks sufficiently for the 
importance of the disease in this age of life. 

" In the historical portion of the work, the author points out 
the fact, that an accurate knowledge of this affection was first 
derived from German and French physicians, while there exist- 
ed, even now, pretty incorrect notions of this disease among 
English authors, with the exception of Dr. Underwood. 

" The following sections comprise very interesting and thor- 
oughly elaborated articles, in regard to statistics, etiology, symp- 
tomatology, course, complications, diagnosis, prognosis, and 
treatment of the disease. In all these particulars, we find the 
author has fulfilled everything that could be expected of a man 
of his diligence and skill. In order to give the reader a correct 
idea of the work, we will endeavor to present' a condensed state- 
ment of its contents, and the conclusions to which it leads. 

" 1. Abdominal typhus is by no means a rare disease among 
children, and is observed among them in a sporadic, as well as 
in an epidemical form. 

"2. It more often attacks male than female children. 

"3. The number of fatally ending cases is smaller among 
children than among grown people ; and, again, greater among 
female than male patients. 

u 4. In the very first years of life the disease is rare ; becomes 
more frequent from the second year, and reaches its greatest ex- 
tent from the sixth to the eleventh year. From that it decreases 
again up to the time of puberty ; mortality is greatest from the 
first to the fourth year. 

"5. Boys generally die sooner from the disease than girls, 
because the fever commonly has a more rapid development 
among the first. 

" 6. Abdominal typhus and scarlet fever exclude one another, 
so that while one of these epidemics is raging, the other disap- 
pears, or is seen only in isolated cases. 

k. s.— vol. xrv. no. rv. 12 



268 Abdominal Typhus of Children. [April, 

"7. Typhus epidemics have been observed in small circuits, 
which seized exclusively upon children, while grown persons 
were not taken at all, or only in some isolated instances. 

"8. The pathological lesions among children are about the 
same as in grown persons, especially in regard to enlargement 
of the spleen. But in children there is very rarely found a de- 
posite of material in the intestinal tube, or genuine typhus ulcers. 
There are generally found only a few single infiltrated follicles 
in the glandular placques, which return to the normal condi- 
tion, without even leaving a cicatrix, by a resorption of the 
infiltrated matter, or, more often, by rupture of the follicle open- 
ing into the intestinal tube. The rupture and discharge into 
the intestinal canal is generally observed only to a small extent. 
Moreover, the formation of ulcers in the mucous membrane of 
the pharynx, oesophagus, trachea, &c, is of rare occurrence 
among children. 

" 9. As decided causes of the disease, we have to consider 
poverty, uncleanliness, improper food, and, above all, impure 
air, and a damp, dark abode. Moreover, acclimatization, sud- 
den change of the former mode of living, entrance into new 
conditions of life, have their influence upon the origin of the 
disease. Still, the most important point is the character of the 
epidemical constitution. Scrofula seems to be not favorable for 
the development of typhus fever among children. 

" 10. The most reliable symptoms are the tumor of the spleen, 
diarrhoea, meteorismus, and the abdominal gurgle. Fever, ac- 
celerated respiration, and catarrh of the bronchial tubes are 
equally constant symptoms. The scarce and trifling intestinal 
hemorrhages at the beginning of the disease establish the fact, 
that the local disease is unaccompanied by a severe congestion. 
Seldom does the typhus fever of children invade with chills, as 
is the case with grown people. Delirium and drowsiness are 
generally present, but not very intense. Koseola is often ob- 
served, not so much a papulous eruption, and at a later period, 
sometimes miliaria are seen. The extent of the exanthema does 
not seem to depend upon the intensity of the disease. 

" 11. Abdominal typhus generally appears in a milder form 
among children, its duration being from sixteen days to several 
months. 

"12. Its complications with parotitis, phlebitis, and hemor- 
rhages, are far more seldom odserved in children than in grown 
persons. During recovery, measles, smallpox, and other erup- 
tions may be developed, 

"13. The most common termination is recovery, which gen- 
erally proceeds very fast, while tuberculous, gangrene, intestinal 
ulceration, abscess, or atrophy of the mesenteric glands are 
of rare occurrence among children. Tubercles, if present in 



1858.] Acute Internal Inflammation. 269 

small quantities, seem to be liable to calcination during typhus 
fever. 

" 14. The most important points in diagnosis are the enlarge- 
ment of the spleen, the roseola, the increased temperature of the 
skin, the diarrhoea, the meteorismus, the painfulness about the 
abdomen, the coecal gurgle, the bronchial catarrh, the symptoms 
of cerebral disturbance, and the prevailing epidemic. 

"15. The following symptoms are of the greatest importance 
in prognosis, which is generally favorable : the character of the 
epidemic, the external conditions of life, age, and sex. Compli- 
cations and remaining diseases prove often more dangerous than 
the fever itself in its greatest intensity. 

"16. Experience has taught that the expectant treatment is 
the best that can be pursued. It is impossible to cut short ty- 
phus fever ; still, medium-sized doses of calomel, given from the 
fifth to the eighth day of the disease, have a decidedly good 
effect upon its course. Under all circumstances, we must spare 
the strength of the children, and let them have nutritious food 
in good season." — [N. Y. Jour, of Med., and Banking's Abstract. 



Remarks upon the Treatment of Acute Internal Inflammations. By 
R B. Todd, M. D., F. R. S., Physician to the King's College 
Hospital. 

The case of Jane Cook, aged twenty- two, affords a good illus- 
tration of the phenomena of disease in its most acute form. She 
has had pericarditis in connection with rheumatic fever, some 
degree of endocarditis, and pneumonia with consolidation of 
about a fourth of the posterior part of each lung. 

This patient is rapidly recovering, and, indeed, in an illness 
of unusual severity, she has had no serious drawback. On the 
2nd of July rheumatic symptoms first showed themselves in pains 
and swelling of the lower joints. On the 6th of July a pericar- 
dial friction sound was first heard over the base of the heart, 
which soon became distinctly audible over its whole anterior 
surface. On the 7th bronchial breathing was heard at the pos- 
terior part of the lower third of the left lung, and on the 10th 
the right lung was similarly affected and to an equal extent. 
On the 12th vesicular breathing began to be audible in both 
lungs, and the bronchial breathing to disappear. 

Now this patient was treated in the manner in which (with 
but slight modification) I have been for some years in the habit 
of dealing with similar internal inflammations, especially those 
of the lungs and heart. Although my practice in such cases is 
now pretty well known, and I am proud to think is practised by 



270 Acute Internal Inflammation. [April, 

very many of my pupils in various parts of this city and of the 
country, it may be useful if I take this opportunity of explaining 
to you the principles upon which it is based. 

On admission, while yet it was uncertain how far the rheuma- 
tic symptoms would extend, she was treated with alkalies and 
mild saline purgatives. Bicarbonate of potass in doses of from 
twenty to thirty grains were given every four or six hours, and 
very soon opium was freely given, when the cardiac affection 
manifested itself. As much as one grain of opium was given 
every fourth hour. Care was taken to keep the bowels open by 
giving an aperient draught daily of sulphate and carbonate of 
magnesia. Counter irritation was employ d over the situation 
of the inflamed lungs by means of stupes of flannel soaked in 
turpentine ; these were applied twice or thrice a day, and the 
region of the heart was freely blistered. 

A principal and very important part of the treatment to 
which, as most of you know, I pay very special attention, is that 
which I may call the dietetic portion. The object of this is to 
support the vital powers of the patient and to promote general 
nutrition, during the time when those changes are taking place 
in the frame which tend to check or to alter the morbid process, 
and to convert it into a healing process. 

When a patient suffers from pneumonia, the tendency is for 
the lung to become solid, then for pus to be generated, and at 
last for the pus-infiltrated lung-structure to be broken down and 
dissolved. Such are the changes when matters take an unfavor- 
able course. On the other hand, recovery takes place, either 
through the non-completion of the solidifying process, or by the 
rapid removal, either through absorption, or a process of solution 
and discharge of the new material, which has made the lung 
solid. 

It will scarcely be affirmed, even by the most ardent believer 
in the powers of the Therapeutic art, that any of the measures 
which are ordinarily within our reach, such as the administra- 
tion of certain drugs, or the abstraction of blood, or the applica- 
tion of blisters, exercise a direct influence in effecting these 
changes. Save in the case of antidotes, which directly antago- 
nise the proximate cause of the morbid state, medicines promote 
the cure of acute disease by assisting and quickening some natu- 
ral curative process. And he is the wisest practitioner, and will 
be the most successful therapeutist, who watches carefully the 
natural processes of cure — in other words, who studies the phe- 
nomena, both anatomical and physiological, which accompany 
them, and of which, indeed, they consist. 

Let me therefore, exhort you to look very carefully to this as 
a part of your clinical study. If you will be on the look-out, you 
may often meet with cases of acute disease which recover with 



Acute Internal Inflammation. 271 

little or no medical treatment, and von may observe and note 
the clinical phenomena which they exhibit. 

Allow me to anticipate your observation on this point, and to 
point out what you may look for in cases of pneumonia, and 
what you will certainly find in almost every instance. 

First, the hot, often burning skin, which is so generally pre- 
sent in the first stages of pneumonia, will be exchanged for one 
bedewed with moisture, generally to the extent of free sweating. 

Secondly, along with this sweating process there will be one 
of increased flow of urine, and very often a free precipitate of 
brick-dust sediment, lithate of soda, more or less deeply colored. 

Thirdly, not unfrequently expectoration becomes freer, the 
sputa are more easily discharged, they lose their characteristic 
reddish, rusty color, and often they become very profuse and 
even purulent. Now and then the purulent sputa are so abun- 
dant that it is difficult to imagine that they can have come from 
any other source than an abse 

Fourthly, the chemical characters of the pneumonic sputa ex- 
hibit an interesting contrast with those of the urine. In the 
heights of the inflammatory state, the sputa contain common 
salt (chloride of sodium) in abundance, andthe urine is entirely 
devoid of it. As the inflammation becomes resolved the salt 
returns to the urine and leaves the sputa. 

Lastly, while all these changes are going on, the physiological 
functions which have been disturbed by the local malady, grad- 
ually approach their normal state. The quickened breathing, 
the accelerated pulse, the unnatural general generation of heat 
gradually subside. As all these admit of being measured by 
numbers, you should tabulate them in your records of cases, 
and you will find on each succeeding day (under such circum- 
stances as I am now referring to) the figure assignable to each 
function gradually become lower until you arrive at the normal. 

Xow is it not plain from all this that the process of resolution 
of pneumonia is a distinct natural process, afiected by the vari- 
ous physical agencies which are concerned in the nutrition of 
the lung ? A material with clogs the air cells and minute tubes 
is removed, chemical changes of the most marked and obvious 
kind accompany the deposition and the removal of this material, 
and certain functions of excretion become strikingly augmented, 
as if for the purpose of getting rid of some noxious matter out 
of the circulation. A more exact and minute analytic chemis- 
try than we have at present will, at some future time, beyond 
doubt, detect more minute changes in the blood, and determine 
the exact nature of the discharged matters. 

One other remark I must make in connection with this sub- 
ject. These acute internal inflammations are very often — I sus- 
pect always — connected with the undue prominence of some 



272 Treatment of Phagedenic Ulcers. [April, 

peculiar diathesis — the gouty or the rheumatic, for instance — 
sometimes the scrofulous. Of these diatheses the main charac- 
teristic is the generation of some peculiar morbid matter which, 
when accumulated in undue quantity in this or that organ, gives 
rise to inflammation in it. And the determination of the mor- 
bid matter to the lung, or the pleura, to a joint or a muscle, will 
often depend on the direct influence of cold, or of an unwanted 
amount of exercise, or of some mechanical injury. The evil is 
to be remedied by the diminution of the intensity of the diathe- 
sis. This is done naturally, and is to be imitated artificially, by 
the elimination of the morbid element through the channels of 
augmented excretions, such as the sweat, the urine, and the se- 
cretions of the alimentary canal. 

You will perceive, then, that my argument may be thus 
summed up. Internal inflammations are cured, not by the in- 
gesta administered, nor by the egesta promoted by the drugs of 
the physician, but by a natural process as distinct and definite 
as that process itself of abnormal nutrition to which we give the 
name of inflammation. What we may do by our interference 
may either aid, promote, and even accelerate this natural ten- 
dency to get well ; or it may very seriously impair and retard, 
and even altogether stop, that salutary process. 

If, then, this view of the nature of the means by which inflam- 
mation is resolved in internal organs be correct, it is not unrea- 
sonable to assume that a very depressed state of vital power is 
unfavorable to the healing process. Indeed, if you watch those 
cases in which nothing at all has been done, or in which noth- 
ing has been done to lower the vital powers, you will find that 
the mere inflammatory process itself, especially in an organ so 
important as the lung, depresses the strength of the patient each 
day more and more. — [Archives of Med., and Amer. Med. Monthly. 



On the Treatment of Phagedenic Ulcers by Irrigation. By Dr. J. 
Sutherland, Surgeon to the 8th Kegiment of Native In- 
fantry. 

When Dr. Sutherland was putting this mode of treatment in 
practice in the regimental hospital at Dinapore, he was not aware 
that a similar mode of treatment had been adopted by Mr. Cock 
at Guy's Hospital (v. " Abstract," XXIY. p. 120). Dr. Suther- 
land was led to adopt this plan of treatment by an observation 
of the case first in order. 

Cases. — A young soldier, a Seikh, had been under treatment 
for intermittent fever with enlarged spleen, and was taking 
iodide of iron and quinine ; at this time a slight sore situated 
over the spleen took on a phagedenic character, spread rapidly, 



1858.] Treatment of Phagedenic Ulcers. 273 

and threatened to involve a large portion of the abdominal pa- 
rietes ; the usual treatment, constitutional and local, was adopted, 
with little effect in arresting the spread of the ulceration ; there 
was considerable fever and great pain in the dark and inflamed 
ring around the sore, nitric acid had been applied without effect, 
and the patient was very importunate for relief; morphia was 
given at bed- time to allay pain and procure sleep ; under these 
circumstances it occurred to me that benefit might be derived 
from a continuous washing away of the morbid discharge as it 
was formed, and that water, made slightly warm, would be a 
bland application to the extremely irritable sore; accordingly I 
decided on having a continued dripping of tepid water over the 
foul ulcerated surface ; [this was effected by allowing the water 
to flow along a skein of thread, one end being placed in a vessel 
of water above the level of the bed, another end of the thread 
(or, what answers the purpose nearly as well, a strip of calico) 
being placed over the sore. 

The result of this treatment surprised me ; an almost immedi- 
ate arrest of the phagedenic ulceration took place, and pain and 
irritative fever quickly abated ; from this time the cure was ra- 
pid, the sore granulated kindly, and in about ten days a large 
ulcerated space was filled up with healthy granulations. 

The second case in which the remedy was used was equally 
satisfactory ; the patient, a weak young man of a strumous dia- 
thesis and a constitution tainted with syphilis, had a bubo in the 
left groin, extensive sinuses (in the groin), had been laid open 
and the sore was healing favorably when it suddenly took on a 
phagedenic character and spread in all dir actions, forming an 
extensive sore, which, extending upwards, threatened to pene- 
trate the abdomen ; having observed the satisfactory result of a 
continuous dripping of water over an ulcerated surface in the 
case above detailed, I was led to subject this patient to the same 
treatment; the result was equally gratifying, an immediate arrest 
to the spread of the ulceration took place and the sore healed 
rapidly ; quinine, ammonia, with tinctura opii, which had been 
given some days previous, were continued for a short time, but 
no other local remedy was used to complete the cure. 

The third case was that of a sepoy of the 1ST. I.; this man 

was admitted into the station hospital with an extensive ulcer 
on the right hip of eighteen months' standing ; according to the 
statement of the patient, he had been fourteen months under 
treatment in his regimental hospital, and, all applications hav- 
ing failed to heal the sore, he got leave to visit his home that 
change of air might do him good ; the sore becoming worse, he 
applied for admission into the station hospital in this place ; the 
ulcer was superficial, with jagged edges and unhealthy flabby 
granulations ; there were several small, deep, foul ulcers around 



274 Treatment of Cicatrices from Burns. [April, 

the large ulcer, at distances varying from one to five inches ; the 
patient was, at first, very unwilling to submit to the treatment 
(as it required him to lie in a constrained position), asserting, 
with much appearance of truth, that he had not benefited by all 
that had been done for him before ; he has been under treat- 
ment since the third instant, and the large sore has completely 
healed under the irrigating system, all the smaller ulcers have 
also healed, with the exception of two that could not be subject- 
ed to the treatment, owing to their position. 

I think it probable, from the nature of the ulcers, that the ad- 
dition of sulphas zinci or nitras argenti to the water would have 
expedited the cure, but I was unwilling to make the addition, 
as I wished to try the action of pure water alone on the sores. 
[Indian An. of Med. Science, and Ranking\s Abstract. 



On the Treatment of Cicatrices from Burns. By Mr. Skey, Sur- 
geon to St. Bartholomew's Hospital. 

On a recent occasion, we had an opportunity of seeing the 
plan adopted by Mr. Skey, at St. Bartholomew's Hospital, for 
removing the contraction of tissues consequent upon a burn. 

The patient was a little girl (Emma B , set. 6 years), the 

front of whose neck had been burnt some years before, and had 
so contracted as to produce a number of distinct bands, running 
from above downwards, without very great deformity. The 
contraction resulting from the burn was treated, whilst the girl 
was under the influence of chloroform, by making a number of 
short transverse incisions in various parts of the cicatrized tis- 
sues, which gaped as they were made. This plan Mr. Skey has 
found very efficacious in some eight cases, all of which have 
done very well. It has certainly the advantage over dissecting 
up portions of cicatrized skin, in that there is no danger nor risk 
of sloughing — an accident which not unfrequently makes a case 
worse than if nothing whatever had been attempted. 

On a subsequent visit, we found these transverse healing well, 
without any appearance of contraction of the cicatrix. She lay 
upon a flat bed, with her head considerably lower than the 
shoulders, and the wounds are dressed with narrow pieces of 
strapping, so as to approximate the ends of a cut to each other — 
not the sides — and lengthen out the old cicatrix as much as pos- 
sible. — [Lancet, and Ibid. 



Diphtheritic, or Malignant Sore Throat. 

Benjamin Godfrey reports four cases of this disease, and be- 
lieves the order, in which its symptoms generally occur, to be 
this: Shivering; intense depression; dryness and tingling of 



15»:-5 " P"-'- : •" ."""- :~ v>i -.',-■:::'. .:/'.■■.",:■':: :~ m^m:.m; _"' 

fli ^* l^EKMfcl^ nares alio! <f^rs : 

whitish spot on die ma nual membmneof 

deepening in color bb Ike 

dLstkse appears to u?. Godfrey no 

membrane, neither iimdiin g lac 

tore. The glandular enllargemondi is 

tk». Its dsagsftosfae diffiaeo ce from 

L Tne absence of all ferer, i Absence of ill not, S. PapOba 

c:me :;::- m; :^::0 ~ >\ iesmmmmm ::' me :m__e 

me: me m>v;.m ....fires :zi m mmmme v.z.: — imf me ms:m:f 

:;m_f 7.-:mm me":mml mi ': mm :i> ~m :m : :: -_r_ .mmm.:- 

-r~'::^r. mi if ;mmm so.mr:.: mm :07mm r Im m- 
:re:m mi :m.i iem-ess;::: if .mm mm_ec :~ me :e;:ef:mm :: 

r- •■* : -r~ •■"' sdrl-: mrer. ::me :oi-mse ::' -L^...l. 'm mm 

:,:-::: mm i.:C mmmm :.: mo mm. :.i:::^:i mi iimmi 
aspn jnria. The mam point in the treatment k to aajupiMt Ac 
:..^.i-'i 10-mrs, :t rmmmmif ,:: :::::^ mi :.: meoi: mf 
mrmi :f:m mmme m :m immmmm :: :m 5r;:: romeom 

;mi:m:'s pmu-eos is :m mmm: mm ii_r i;.-f-;mm mi me if- 
l-:esmm.~7«mm ,:o;m: ioime me l-r^v_£ :=■*. mm:; resm; 
mm: -o: mmi :01m; mmmmm ,c;v,:C "1 _mmmm ;: me mi- 
m"_s emmoi .is 1 mmjmi s-mm.m m erem mm _ :. momej 
believes die tinctnre of a^nkMoride of iron die best remedy. 



Onf^e Pr&xaJs^^^ By Pm£ 

Dbsoubaix 



Professor Beraobaix, Suigeon to d» St Jea% BraoBel^ 

iiims 1 series ;: imors ';:•:: mis si mo; "-mi. me :':'_:vz: 

1. ItktodnfrofasaigeQmtoaeehv ty the hmpranremart of 

m memm.-e mm :im<. :.; :"m.me me mms" m:me-is :•:' 
memmim me eiiem:: ;.; mooveo me zem :: irmemim :: 
me s-:::rv .mi: i mm ~'i:.:z me im rmre imoemm is smi 
imme imjormism immieo 1; im imis. 

2. Ooold the great amgical ope mt M i ns be rendered fern dan- 
gerens in diom a d f o^ ■■ inserrentLoa c* szr^rr womb] b? 
much, more deudy and more fiwjnenisi'T m&sstec i£ 
tbe praetiao^ex now often is obfrgnd to remain a 
:m ;:' i:-;:-ier< v.-r.m imij m-me :m 

S. Tke dajager of great ©perij^^ 
sanaces concerned, bat to the nnmber and Tomine of the 



276 Prevention of the Ill-consequences of Operations. [April, 

4. When the division of veins proves mischievous, it does so 
by giving rise, through a mechanism the nature of which it is 
not always easy to appreciate, to the production of purulent in 
fection, one of the most fearful consequences of traumatic lesions. 
The great danger and extreme frequency of this complication 
justify the efforts made for its prevention or removal. 

5. There are two directions, both perhaps equally good, by 
following which we may succeed in rendering pyaemia of much 
less frequent occurrence. The first of these consist in improving 
and rendering less uncertain the process of healing by the first 
intention ; and the second in so modifying the divided surfaces 
as to convert them into a lesion of continuity of far less danger- 
ous character. 

6. Metallic caustics, at least in the immense majority of cases, 
do not give rise to purulent infection ; but they are not applica- 
ble to certain operations — as, e.g., amputations. 

7. It is rational, then, when seeking for substitutive or modi- 
ficatory means for the prevention of pyaemia, to resort to such 
as most resemble caustics in their mode of action, and yet are 
exempt from the disadvantages of these therapeutical agents. 

8. The tincture of iodine would seem to possess properties en- 
abling it to fulfil these indications, seeing the deep-seated modi- 
fication it impresses on the tissues, and the plastic effects it gives 
rise to. It does not act upon the ligatures, and therefore does 
not give rise to the danger of secondary hemorrhage. When it 
is applied to bleeding surfaces after an operation, it induces a 
general hyposthenic effect of short duration, and a local hypos- 
thenic effect, which imparts peculiar characteristics to the gran- 
ulations and cicatrization. 

9. The most remarkable results of this hyposthenization are, 
the much less indolence of the wound, the slight amount of 
suppuration, the notable diminution of the general reaction, and 
the maintenance of a condition approaching that of health. 
These phenomena offer no impediment to rapid cicatrization. 

10. The discharge from the surface of the wound is consider- 
ably diminished as a consequence of the application of the tinc- 
ture ; but this does not prevent artificial hemorrhage, or the loss 
of blood from the large veins. 

11. The putridity of the wound becomes evidently diminish- 
ed ; and when the tincture is applied to the divided extremities 
of the veins, these become corrugated and narrowed, and then 
agglutinated. If phlebitis arises, it is obliterative and adhesive, 
not suppurating. 

12. The application of the tincture to the sawn surface of the 
bones does not lead to necrosis. 

13. The tincture imparts no preservative power against pyae- 
mia when an open venous orifice, through which pus may be 



1858.] Treatment of Ununited Fracture. 277 

easily, so to say, mechanically introduced, exists at any point of 
the surface. 

14. In ordinary cases, even the tincture is no certain prevent- 
ive of purulent infection. When, after it has been applied, we 
find the vicinity of the wound remaining very painful, we 
should suspect a commencement of phlebitis, and the course of 
the pain should be carefully inquired into. 

15. It should be remarked, that as the general hypostheniza- 
tion which results from the application of the tincture exhibits 
itself in symptoms, comparable to a certain point to those pro- 
duced by chloroform, prudence is required in the simultaneous 
or successive employment of the two substances. Perhaps this 
is the principal defect of the iodine. 

16. The injection of the tincture into the veins is immediately 
fatal. It induces an entirely peculiar coagulation of the blood, 
incapable of being confounded with any other pathological or 
spontaneous coagulation. 

17. Nevertheless, this medical substance cannot, when applied 
to a bleeding surface, be carried in substance into the current of 
the circulation, unless, indeed, venous orifices be maintained 
open by adhesions. It is absorbed in the state of an alkaline 
iodide, and may be found in such a state of combination in the 
blood and urine. The amount ordinarily absorbed exerts no 
ill-effect upon the economy. — [Presse Med. "Beige, Med. Chir. Bev. 
and Banking's Abstract. 



On the Treatment of Ununited Fracture. By Mr. Syjie, Professor 
of Clinical Surgery in the University of Edinburgh. 

" When there is merely a slight degree of mobility at the seat 
of injury, so that, although quite sufficient to prevent any useful 
exercise of the limb, it may require some care for its detection, 
there will be a favorable prospect of success, even after the ex- 
piry of several months, through the employment of means for 
the complete prevention of motion ; and I have put upon record 
cases in which even the thigh-bone was rendered perfectly rigid 
by this simple expedient, in circumstances of apparently a very 
hopeless character, from the long duration of flexibility. But 
when the extremities of the bone remain quite separate, or even 
overlap each other, and are surrounded by a sort of fibrous cap- 
sule with cellular interstices, so that they admit of hardly less 
free motion than if there really were a joint between them, it is 
evident that merely preventing motion could not possibly prove 
sufficient for the production of an osseous union. It has been 
supposed, that the difficulty thus presented might be overcome 
by rubbing the ends of the bones together ; by stirring up the 
texture connecting them through the agency of needles or teno- 



278 Treatment of Ununited Fracture. [April, 

tomy knives ; by passing setons through the flexible medium of 
union ; and by inserting pegs of ivory into the respective osse- 
ous surfaces. But, so far as I am able to form an opinion on 
the subject, all of these means are absolutely useless, and owe 
any share of credit that they may have acquired to the preven- 
tion of mobility which is conjoined with their employment. In 
short, I believe that the procedures in question cannot accom- 
plish recovery in any case not remediable by the enforcement 
of rest, and that they consequently, must always be useless, if 
not injurious. There is still another mode of treatment, which 
consists in cutting off the ends of the bone, so as to obtain two 
fresh osseous surfaces, and place the limb in a condition simi- 
lar to that of a compound fracture recently inflected; and 
this, I feel persuaded, affords the only reasonable ground for 
expecting success in cases not amenable to the influence of im- 
mobility. It is true that the experience of this method has not 
hitherto been at all satisfactory, through want of due attention 
to some circumstances in the mode of procedure, which must in 
a great measure determine the result. Of these may be special- 
ly mentioned an imperfect removal of the ends of the bone, and 
a want of complete immobility after the operation. The follow- 
ing case will, I hope, tend to illustrate the importance of attend- 
ing to these points. 

Case. — " J. H , aet. 34, a private of the Foot, while 

discharging some duty in the Kedan, on the 8th of December, 
1855, after the occupation of Sebastopol, was blown up by a 
Eussian mine, which had escaped detection, and, in addition to 
some slighter injuries;, sustained a fracture of the left arm be- 
tween two and three inches above the elbow. He walked up 
to his regimental hospital, where splints were applied, and re- 
tained for a month, when, there being no signs of union, the 
ends of the bone were rubbed together, and supported by a 
starched bandage. He left the Crimea on the 3d of February, 
and was sent to the hospital at Eenkioi, where a seton was 
passed through the seat of fracture, and retained for five weeks 
without any benefit. On the 20th of May he proceeded home- 
wards, and, after a long voyage of nearly two months, arrived 
at Portsmouth, whence he was transferred to Chatham on the 
17th of July. No attempt to restore rigidity was made there, 
and at the end of two months he was dismissed the service, with 
a pension of one shilling per day, in consideration of his disabil- 
ity, which was regarded as equal to the loss of a limb. 

"In the hope that relief might still be afforded, he applied to 
me on the 22nd of January last, nearly fourteen months from 
the date of the injury ; and finding that the arm was entirely 
useless through the extreme mobility of the ends of the bone, 
which overlapped each other to the extent of more than an inch, 



1858.] Reproduction of Bones and Joints in Whitlow. 279 

I resolved to adopt the only procedure that, in my opinion, 
afforded any reasonable prospect of remedy under such circum- 
stances, which was to remove the ends of the bone, and after- 
wards maintain the most perfect rest. In preventing the motion 
of a joint, it is a most important principle, never to be forgotterj, 
that as most of the muscles pass over two articulations, it is im- 
possible to keep any one perfectly quiet without placing the 
whole limb under restraint. Proceeding under this impression, 
my first step was to have the arm put in an easy position, with 
the elbow bent at a right angle, and then covered from beyond 
the shoulder to the tips of the fingers with pasteboard and 
starched bandages, so as to form a case, which, when it became 
dry, effectually prevented the slightest movement in any of the 
joints. This case was next cut up on one side from end to end, 
so as to allow the arm to be taken out of it, and undergo the 
requisite operation, which was performed under chloroform. 
An incision having been made along the outer edge of the tri- 
ceps, I exposed the upper end of the bone, and sawed off a 
portion of it sufficient for obtaining a complete osseous surface. 
The lower end, lying anterior to the shaft in a sort of capsule, 
could not be subjected to the saw, but was removed, to the ex- 
tent of more than an inch, by cutting pliers. The arm was 
then supported by a couple of splints, and the patient lay quietly 
in bed for a fortnight, when the limb was placed in its paste- 
board case, in which an aperture had been made over the wound 
then nearly healed, and discharging a very little matter, that 
soon ceased entirely. The patient, feeling that the slightest 
motion was impossible, even if he had wished it, was relieved 
from any further restraint, and no longer remained in bed. At 
the end of a month, or altogether six weeks from the date of the 
operation, which was performed on the 30th Jannary, the limb 
was examined, and found to be quite straight, with a firm osse- 
ous union ; so that the patient was able to leave the hospital, 
not only with his comfortable pension, but also with a perfectly 
useful arm." — [Edinburgh Med. Jour., and Ibid. 



Reproduction of Bones and Joints after their Removal in cases of 
Whitlow. 

Some time ago Dr. Toland, of California, claimed the discove" 
ry of this important fact in surgery. In the February number* 
1858, of the Buffalo Medical Journal, we find, however, that to 
Professor Dudley, of Lexington, Kentncky, is due the credit of 
having made the discovery, and to Professor Hamilton, of Buf- 
falo, N. Y., is due the credit of having first promulgated the idea 
through the medium of the medical journals. Doubtless we 
shall soon have some more discoverers in the field. But this is 
all right. We say, " honor to whom honor is due." 



280 Case of Transfusion. [April, 

During five years practice in the country, it was our lot to 
encounter a great number of these cases of paronychia among 
the plantation negroes. Indeed, strange as the idea may seem 
to some, we are sure of having witnessed the disease once in an 
epidemic form. Throughout an entire neighborhood the disease 
was strictly prevalent, and we can now call to mind several ne- 
groes who lost the first phalanx of two or more fingers in one 
season. Of course the vast majority of the cases lost the first 
phalanx, as every overseer and old woman in the country ima- 
gine themselves fully competent to treat, or rather cure whitlow 
or bone felon. When the doctor is called in, the bone is loosen- 
ed from its attachments, and he has no alternative but to remove 
it. When we first encountered the cases, such was the degree 
of the disease of the surrounding tissues, we amputated the end 
of the finger ; but observation soon taught us that this proce- 
dure materially diminished the value of the cotton-picker, as the 
finger was not only considerably shortened, but the stump, un- 
protected by the nail, was continually subject to injury. We 
then resorted to the plan of picking out the dead bone, and the 
only deterioration the hand suffered was comparatively slight 
shortening of the finger. In no instance have we ever seen any 
thing approaching reproduction of the bone — and this notwith- 
standing we have carefully supported the finger by means of 
splints and bandages. — \N. Orleans Med. News and Hosp. Gaz. 



On a Case of Transfusion, By John Wheatcroft, Esq., M. R. 
C. S, L .S. A., Cannock. 

In the Lancet of October, there appeared a case of transfusion 
of blood, which operation I again performed successfully on the 
25th inst. The following are the particulars : — 

I was summoned to see Mrs. , aged thirty-two, on the 24th 

instant. I found her in an almost exsanguined condition. A ter- 
rible gush of blood per vaginam had suddenly occurred, followed 
by coagula two or three pounds in weight. Her neighbors with 
difficulty got her up stairs, and again haemorrhage set in frightful- 
ly. I found her lying on the bed in a state of great exhaustion ; 
face white and anxious ; lips blanched ; skin and extremities cold ; 
pulse small, very feeble, and rapid, 120 per minute. 

I immediately plugged the vagina, administered the yolk of 
egg with a little brandy, enjoining upon the attendant strict at- 
tention to the ordinary methods adopted in uterine haemorrhage. 
On visiting the case four hours afterwards, I found the plug right, 
and the bleeding had been arrested ; a little more colour in the 
lips; the pulse 100, but small and thready; complained much of 
giddiness and severe uterine pain: she was three months ad van- 



1858.] Pulmonary and Bronchial Tuberculosis. 281 

ced in pregnancy. I then gave her small doses of tincture of 
opium, but vomiting having supervened, every dose, together 
with the egg, was rejected. Small doses of sulphuric ether arrest- 
ed the sickness. I left her, apparently going on favorably, but in 
four hours was again hastily summoned. She had complained of 
severe expulsive pain, violent retching accompanied it, and ex- 
pelled the plug, together with a large coagulum ; the flooding re- 
commenced, and I found her lying in a large pool of blood. I 
could detect no foetus either in the bed or the vigina ; the os uteri 
was too high to be reached ; the skin and extremities had again 
become cold, the surface of the body as white as snow ; pulse 
almost imperceptible ; the breathing gasping ; face very anxious ; 
great restlessness ; loss of vision ; eyes sunk and leaden. 

Ably assisted by J. Blackford, Esq., and Mr. Samuel Wheat- 
croft, I transmitted about two pounds of blood from the husband. 
The change was immediate (I had previously replugged the va- 
gina;) the colour returned to her lips, the eye became brilliant, 
the pulse distinct and firm, the restlessness vanished, the breathing 
became normal, and she now looks, with the exception of her 
whitened skin, as well as I ever saw her. Although complaining 
of giddiness and tightness across the brow, she is quite cheerful. 
The fetus has not been expelled. I have removed the plug, and 
there is not a drop of blood to be seen. The plug here was as 
valuable as the transfusion. 

Permit me to suggest the trial of this operation in the last stage 
of low typhus and the colapse of Asiatic cholera when every other 
means have failed. — [London Lancet. 



Pulmonary and Bronchial Tuberculosis. 

Every physician acquainted with the methods of physical 
exploration — and we readily believe every one is now-a-days — 
ought to know, that tuberculosis is not at all uncommon in chil- 
dren. The symptoms are generally known ; the prognosis not 
so unfavorable as in adults. This statement is affirmed by Dr. 
J. Schwartz, of Berlin, who reports to have repeatedly succeed- 
ed, by careful regulations as to their diet, and some well-adapted 
pharmaceutical remedies, in restoring to health children of from 
two to five years, who were already considerably emaciated, 
and subject to hectic fever. Against the attack of hectic fever 
he warmly recommended, as Skoda did before him, the sulphate 
of quinine, with small doses of Dover's powder. Besides, he 
gives cod-liver oil and armara, which he says are too little thought 
of in our time, and have been too readily forgotten. — [Journal 
fur Kinderkrankheiten ) and N. Y. Jour, of Med. 



282 Editorial. [April, 



EDITORIAL AND MISCELLANEOUS. 

Medical College of Georgia — Appointment of Professor Joseph 
Jones. — The Chair of Chemistry and Pharmacy in the Medical College 
of Georgia, recently vacated by the resignation of Professor Means, has 
been promptly filled by the unanimous election of Dr. Joseph Jones, 
Professor of Chemistry and Physics in the University of Georgia, 
and formerly, Professor of Medical Chemistry in Savannah Medical 
College. 

Dr. Jones has for years, most ardently devoted himself to original Che- 
mical and Physiological Investigations. His labors have been crowned 
with such brilliant success, that to praise them, on the present occasion, 
could not certainly add to their universally acknowledged merit. His 
contributions to Chemical and Physiological Science have been present- 
ed to the Profession in papers bearing the following titles : 

1st. Abs+ract of Experiments upon the Physical Influences exerted by 
Living, organic and inorganic, Membranes upon Chemical Sub- 
stances passing through them by Endosmose. Read before the 
Academy of Natural Sciences, Philadelphia, October 25th, 1854. 
[Accompanied by lithographic illustrations from original drawings 
by the author, from appearances under the microscope.] 

2nd. Observations upon the Kidney and its Excretions in different ani- 
mals. Published April, 1855, in the American Journal of Medical 
Sciences. [With twenty wood cut illustrations.] Pp. 42, 8vo. 

3rd. The Digestion of Albumen and Flesh, and the Comparative Anato- 
my and Physiology of the Pancreas. Published in the Medical 
Examiner, Philadelphia, May, 1856. Pp. 20, 8vo. 

4th. Physical, Chemical, and Physiological Investigations upon the Vital 
Phenomena, Structure and Offices of the Solids and Fluids of Ani- 
mals. Published in the American Journal of Medical Sciences, 
Philadelphia, July, 1856. Pp. 64, 8vo. 

5th. Investigations Chemical and Physiological, relative to certain Amer- 
ican Vertebrata. Referred by the Smithsonian Institute to Profes- 
sor Samuel Jackson, Professor Joseph Leidy, and Professor Jeffries 
Wyman, with Professor Joseph Henry, Secretary of the Institute, 
as Commissioners ; accepted by them March, 1856, and subse- 
quently published by the Smithsonian Institute. 4to., pp. 137. 
[This work is embellished with 27 wood cut illustrations. It was 
published and distributed at the expense of the Institute.] 

Prof. Jones is a native of Liberty county, Georgia. He relinquishes 
his chair in Athens, where his relations have been of the most agreeable 



1858.] Editorial 283 

and encouraging character, for the sole purposes, as he states, of devoting 
himself more entirely, than he can at present, to Medical Science in its 
Chemical and Physiological departments, and with the view of assisting 
in elevating the standard of Medical attainment at the South. He will 
make Augusta his place of residence, and his course will be eminently 
practical and instructive, especially in the important departments of 
Medical, Physiological and Pathological Chemistry. 

In the next number of this Journal, we shall present to our readers 
an elaborate and most valuable contribution from his pen, on the 
subject of the Chemical and Physiological Relations of the Blood to 
Diabetes. As Editors, we congratulate our readers and ourselves, on so 
valuable an accession to our corps of contributors. 



American Medical Association. — The eleventh Annual Meeting of 
the American Medical Association, will be held in Washington City, on 
Tuesday, the 4th day of May, 1858. 

The American Medical Association has, for years, ceased to be an ex- 
periment ; its wise deliberations, its judicious suggestions for the advance- 
ment of medical science, and for the improvement of medical education 
and medical ethics, have fully vindicated its right to be considered, the 
highest and most authoritative tribunal, in the medical sciences, in the 
land. The time is past, when it may be doubted that its efforts have 
wrought an improvement in the status of the profession ; there are too 
many evidences of the diligent investigation and research, of independent 
experimentation, directly growing out of the spirit which this body has 
infused, for it to be longer doubted, that it has done much good. No 
one will hesitate to admit, that since its establishment, American medi- 
cine has assumed a form, and presents a character of its own and a spirit 
of its own, highly progressive, energetic — indeed, American. Not only is 
this change witnessed at home, but is observed elsewhere. The valuable 
Transactions of this Association are distributed everywhere, and may be 
now found in the Libraries of the Scientific Institutions, throughout 
Europe. It is important then, that this body should, in its present 
dignified position, use great care and judgment in its deliberations. 
There are many important questions to come up before them at 
Washington — some of these are vitally connected with the interests 
of the Profession. We have not time nor space at present, however, 
to present any of these subjects properly, and therefore close our 
remarks with the confident hope that all questions will be discussed 
and determined in the best and wisest manner for the general good of 
the Profession. 

• 11* 



284 



Editorial. 



[April, 



Medical College of Georgia — Annual Commencement. — The un- 
diminished prosperity of the Medical College of Georgia, even under 
the multiplication of institutions throughout the country, we are sure, 
must be a subject of great satisfaction to its many friends and alumni, 
and also to those engaged in a liberal competition in the same field. At 
the last Commencement, the degree of Doctor of Medicine was conferred 
on sixty-one candidates, whose names we take pleasure in here recording : 



Toliver Dillard, 


of 


Georgia. 


J. H. Ruddell, 


oi 


' Georgia. 


Henry Kinnebrew, 


u 


tt 


L. C. Wisdom, 


tt 


tt 


J. J. Denson, 


it 


tt 


Wm. Hadden, 


tt 


tt 


A. G. V. Doney, 


u 


tt 


R. B. McRee, 


tt 


tt 


A. H. Mathers, 


a 


Florida. 


W. A. Childress, 


tt 


u 


R. J. Healey, 


<t 


Alabama. 


J. Y. Bradfield, 


tt 


tt 


S. M. Simmons, 


u 


Georgia. 


P. L. Blakely, 


tt 


S.Carolina. 


Wm. J. Colley, 


ft 


tt 


G. W. Chisholm, 


tt 


Georgia. 


J. W. Lowman, 


ft 


S. Carolina. 


G. W. Pitts, 


tt 


tt 


A. H. Read, 


u 


Alabama. 


H. W. Culver, 


it 


Alabama. 


R. C. Johnson, 


tt 


Georgia. 


E. G. Scruggs, 


tt 


Georgia. 


A. J. Speer, 


tt 


S. Carolina. 


R. M. Hitch, 


tt 


tt 


J. L. Rucker, 


it 


Georgia. 


J. B. Harvley, 


u 


S.Carolina. 


A. J. Flowers, 


it 


tt 


J. R. McAfee, 


tt 


Georgia. 


"W. R. Armor, 


ii 


tt 


J. F. Donehoo, 


tt 


tt 


T. A. Raines, 


(i 


tt 


H. C. Edmunds, 


N 


S.Carolina. 


J. T. Sego, 


ii 


tt 


J. H. Gibson, 


it 


Florida. 


A. A. Delaigle, 


ii 


tt 


E. G. Kirkland, 


ft 


Georgia. 


S. B. Mills, 


ii 


tt 


B. S. Hudson, 


ii 


tt 


J. W. Rhodes, 


u 


tt 


J. F. Martin, 


if 


tt 


A. T. Jenkins, 


ii 


tt 


John Herren, 


it 


Alabama. 


B. F. Stanley, 


ii' 


tt 


J. M. Howell, 


ii 


Georgia. 


S. W. Gardner. 


a 


Mississippi. 


J. S. Smith, 


it 


S.Carolina. 


Wensley Hobby, 


it 


Georgia. 


J. W. Traylor, 


it 


tt 


J. S. W. Johnson, 


it 


tt 


Solomon Newson, 


ii 


Georgia. 


J. R. Cox, 


ii 


tt 


M. R. Cassaday, 


it 


Alabama. 


T. A. Power, 


it 


S.Carolina. 


T. 0. Powell, 


ii 


Georgia. 


G. W. Coxwell, 


it 


Alabama. 


S. A. Tomkins, 


it 


S.Carolina. 


Patrick Todd, 


it 


S. Carolina. 


F. A. Driver, 


ti 


Alabama. 


W. B. Reynolds, 


it 


Georgia. 


J. D. Patten, 


ii 


S.Carolina. 


J. S. Johnson, 


tt 


Alabama. 









R. M. Tindall, M.D., of Mississippi, a graduate of Memphis Medical 
College, was also admitted adeundem gradum by the Board of Trustees. 



Savannah Journal of Medicine. — We have just received the Pros- 
pectus of the above new Journal. It will be published bi-monthly, in 
Savannah, and Edited by Juriah Harriss, M. D., Professor of Physiology 
in Savannah Medical College, and J. S. Sullivan, M. D. — with R. D. Ar- 
nold, M.D., Professor of Principles and Practice of Medicine in Savannah 



1858.] Editorial 285 

Medical College, as associate Editor. We wish for this Journal in pros- 
pectu, a safe and speedy birth, and from the character and ability of its 
Editorial corps we may hope for it a successful career. We will present 
our readers with a more extended notice when we have seen the first 
number, and we will be happy to place it upon our exchange list. 



A Syllabus of Lectures on Materia Medica : delivered at Atlanta Medical 
College, by J. G. Westmoreland, M. D., Professor of Materia Medica, 
&c, in that Institution. 

We have received, through the courtesy of the author, the above vol- 
ume. It is creditably gotten up, and presents a compendious resume of 
the author's Lectures, and will doubtless be found of much assistance to 
those attending Lectures in the Atlanta Medical College. 



Medical Society of the State op Georgia. — The next annual 
meeting of our State Medical Society will be held at Madison, on the 
second Wednesday in April. 

We quote the following from the minutes of the last meeting, held in 
this place, in order to remind the several Essayists of their respective ap- 
pointments : — 

"The Committee on Essays, made the following report of Subjects and 
Essayists for the next meeting — which was received and adopted. 

Dr. J. G. Howard, of Savannah — On Uterine Disease. 

Dr. E. J. Roach, of Pulaski — On the Propriety of Surgical Operations 
about the Joints. 

Dr. H. F. Campbell, of Augusta — On the Rectal Administration of Medi- 
cine. 

Dr. J. M. Green — On the Value of Escharotics in the Treatment of Cancer. 

Dr. R. D. Arnold, of Savannah — On the Pathology and Treatment of Yel- 
low Fever. 

Dr. Ira E. Dupree, of Twiggs — On the Treatment of Prolapsus. 

Dr. Eben. Hillyer, of Atlanta — On the Physiology of Menstruation. 

Dr. V. H. Taliaferro, of Atlanta — On Obstetrical Surgery. 

Dr. X. F. Powers, of Thomson — On Diseases of the Skin. 

Dr. W. S. Meire, of Madison — On the Use of Alcohol in Typhoid Fever. 

Dr. R. Campbell, of Augusta — On Wounds of the Abdomen. 

Dr. I. P. Garvin, of Augusta — On Nervous Irritation of the Stomach. 

Voluntary Communications from any member of the Society are earn- 
estly requested, and will be gratefully received." 

We sincerely hope there will be a full attendance, and that the con- 
tributions, both by appointment and voluntary, will exceed those of any 
previous meeting. 



286 Editorial [April, 

Our Exchanges. — Editorial Changes, Fusions, Enlargements, &c, 
<fec. — We are much gratified to see that there has been great improve- 
ment in the character, style and spirit of our exchanges generally, 
American Medical journalizing, we may indeed feel proud of. There is 
manifested on the part of contributors, much improvement in the way of 
research and independent investigation ; and also on the part of Editors, 
great industry, discrimination and courtesy ; each to a degree, we think 
we may safely say, with few exceptions, unsurpassed by any period during 
the last ten years. We sincerely regret, that the suggestion made some 
years ago by our able predecessor, Prof. L. A. Dugas, of some periodical 
work annually or semi-annually, embodying the contributions of American 
Physicians, has not been more fully carried out. A work entirely and 
strictly devoted to this object would be of great value to the readers and 
writers of this country, and would greatly enhance the credit and repu- 
tation of American writers among their brethren in Europe. The Ameri- 
can Journal of the Medical Sciences (of which we present no distinct 
notice at this time), has for years, with great fairness, presented a careful 
abstract of all American contributions which the editors deemed worthy 
of record ; but we conceive that the republication of entire articles, which 
could only be done in a work devoted to the purpose, would better com- 
pass the above object, than any other plan which could be adopted. 

The North American Medico-Chirurgical Review. — This excellent 
Bi-monthly comes to us in an improved dress. The January number, 
which contains over two hundred pages, presents many valuable Reviews, 
Criticisms and Analyses of works, besides much valuable original matter. 
In the Report of their able collaborator, Prof. S. Weir Mitchell, on the 
Progress of Physiology and Anatomy, we find that a new feature is intro- 
duced, which will enhance the value of the journal. " It is proposed," 
says the reporter, " in future, to present once a year, a complete analyti- 
cal Review of the general progress of Physiology and Anatomy. At the 
same time, and as an essential part of this task, we shall endeavor to 
point out with care whatever advances in these sciences are due to the 
annually increasing labors of our own countrymen." We have been 
not a little surprised, that so discriminating a reporter as Dr. Mitchell 
should have been content with only a frequent reference, to the articles 
of Professor Joseph Jones, of Georgia, and that he did not embody a 
full abstract of his views and results ; for his, have certainly been the 
most elaborate, thorough and creditable experimental investigations 
into the chemical changes of the blood and other fluids of animals, which 
have ever been presented, so far as we are aware of, by any American 
Physiologist. It may be said, however, that it is probable that their 



1858.] Editorial. 287 

great bulk and the permanent form in which these have been published 
by the Smithsonian Institute, rendered their presentation in the present 
report, a matter both of great labor and at the same time a work of 
super errogati on. 

We are much gratified at the favorable notice taken of Dr. W. A. 
Hammond's laborious and almost self-immolating investigations on the 
" Nutritive Value and Physiological Effects of Starch, Gum and Albu- 
men," as presented in his Prize Essay before the last meeting of the 
American Medical Association. And lastly, we may be here allowed also 
to express our gratification at the manner in which he has been pleased 
to allude to our own humble labors. 

We take great pleasure in commending the above Bi-monthly Review 
to the favorable consideration of our readers, for its able review articles, 
for its analyses, and for other valuable matter, more particularly suited 
to this more permanent form of periodical medical literature. 

The Charleston Medical Journal and Review. — This valued ex- 
change, has recently passed from the hands of its former able Editor, 
Dr. C. Hapholdt, and will hereafter be edited by J. Dickson Brims, 
M. D. Dr. Bruns is most favorably known to the Profession as the au- 
thor of a most interesting and able pamphlet, entitled, " Life ; its Rela- 
tions, Animal and Mental." We congratulate the readers of this Journal 
upon his accession to the chair Editorial. It is published by-monthly. 

The Nashville Journal of Medicine and Surgery. — Professor Paul 
F. Eve has retired, and Professor W. K. Bowling has associated with him 
in the Editorial conduct of this valuable work, Drs. R. C. Foster and 
George S. Blackie, as assistants. W T e heartily wish our friend, Dr. Eve, 
all the otium cum dignitate of retirement, and welcome the other dis- 
tinguished gentlemen most cordially into the body Editorial. We con- 
gratulate Dr. Bowling that he. still finds pleasure and satisfaction in his 
literary labors, and ourselves, that we still find him among our confreres. 

The American Medical Monthly, published in New York, and The 
American Medical Gazette, also published in New York, have, like our 
own Journal, been benefitted by an addition to the number of their pages, 
without any change of Editors. 

The Cincinnati Medical Observer and The Western Lancet have 
united under the title of " Cincinnati Lancet and Observer." The present 
work will be edited by Prof. George Mendenhall, John A. Murphy, M. D., 
and Edward B. Stephens, M. D. Drs. Blackmail and Lawson, both able 
journalists, have withdrawn, but there can be no doubt, that the present 
work will be ably sustained by their successors. 



288 Editorial [April, 

The Peninsular Journal of Medicine and The Medical Independ- 
ent, both published at Detroit, Michigan, have effected a happy union. 
The Independent was sustained for one year by our friends, Prof. Moses 
Gunn and L. G. Robinson, M. D., and now becomes amicably incorpora- 
ted with its competitor, under the comprehensive title of " The Peninsu- 
lar and Independent Medical Journal.' 1 '' May this friendly adjustment 
of their mutual difficulties serve to inspire the Peninsular, with a spirit 
of amiability and liberality towards its more distant confreres, and may 
the ink "spilt" in the former contests of these two journals, serve, like 
the blood of Patriots, to cement more firmly their present union. This 
is but " the expression of a pious wish." We regret that Professor Zina 
Pitcher, the late distinguished President of the American Medical Asso- 
ciation, is no longer in this corps of editors ; we hope that his retirement 
may be as happy, as his editorial life has been courteous, dignified and 
useful. 

The New Orleans Medical News and Hospital Gazette, one of our 
most valuable exchanges, has undergone a change of Editors, and is now 
under the management of Profs. D. Warren Brickell and E. D. Fenner. 
This journal, from its commencement, has been most ably conducted, 
and the recent association of our excellent friend, the veteran Fenner, in 
its Editorial conduct, augurs well for its future success. Dr. Fenner has 
the credit of having been the first to establish a Medical Periodical in 
New Orleans. The several volumes of his " Southern Medical Reports," 
are most useful contributions to Medical Science, as well as enduring 
monuments of the pel severing industry and great ability of their author. 

The New Orleans Medical and Surgical Journal. — This excellent 
Bi-monthly Journal and Review still maintains its high position in the 
comparative estimation of our exchanges. The work has passed into 
the hands of Drs. W. Stone, J. Jones, and S. Chaille, who have also be- 
come assistant Editors, while Dr. Bennett Dowler still retains the posi- 
tion of Editor-in-chief. 

The Memphis Medical Recorder. — We have on a former occasion 
noticed the resignation of Prof. A. P. Merrill from the Editorship of this 
journal, and also at that time signified our great satisfaction with the 
appointment of our friend, Professor Daniel F. Wright, to that position. 
Whatever may be the future changes and improvements in this highly 
useful and creditable work, we here earnestly express the wish that he 
may still wield a pen for its pages, and long remain as now, our valued 
and courteous confrere; 



1858.] Editorial and Miscellaneous. 289 

The Southern - Journal of the Medical and Physical Sciences. — 
The Editor of this Journal, Professor EL 0. Curiy, of Knoxville, Term., 
who has ably sustained the work for several years, suggests certain 
changes in its arrangement and management, which will be doubtless 
beneficial to himself and to the journal. As the work has as yet under- 
gone no change, we defer, till some other number, a more extended 
notice of it. 

The Medical and Surgical Reporter. — TTe have just seen, in the 
Boston Medical and Surgical Journal of March 25th, that " the Reporter 
is about to be removed from Burlington, X. J., to Philadelphia, and that 
Dr. "William B. Atkinson, of the latter city, who has for some time past 
been a regular contributor to its pages, will be associated with Dr. Butler 
in its editorial management." We think, too, that Philadelphia presents 
a good opening for a monthly journal. The Reporter has ever been an 
agreeable visitor with us, and whether it comes from Burlington or from 
Philadelphia, we shall greet it with the same welcome. 

There have occurred doubtless other changes in our exchanges, which 
we at present omit from their having escaped our notice — as thev occur 
to us, we will take great pleasure in recording them. 



Forensic Medicine. — M. Collongues, in a note presented to the Acade- 
miedes Sciences {Comptes Rendus, 21st Dec. 1857, p. 1048), points out 
the usefulness of knowing whether there is a peculiar sound or not to be 
found if death exists. He has already announced that during life there 
is in all the parts of the body a peculiar sound, which may be heard 
easily by the application of the ear, or with the help of averv small 
stethoscope. This sound disappears after death, but not immediatelv. 
It may last five, ten, and even fifteen hours after the last beating of the 
heart. It disappears gradually, and according to the author, its com- 
plete absence from all the superficial parts of the body, is a positive si^n 
of death. In an amputated limb it persists a few minutes. — [Nem York 
Journal of Medicine. 



Fistula in Ano in Relation to Pulmonary Tuberculosis. Bv P. H. 
Strong, M. D. — Dr. Strong embodies in the following formula the doc- 
trine generally held with regard to this subject : 

M The relations of fistula in ano to pulmonary tuberculosis are such, 
that its presence, either as antecedent to or coexistent with the latter, is 
a desideratum, and to be sedulously cherished, having reference to its 
(pulmonary tuberculosis) prevention in the one case, and to its cure or 
favorable modification in the other." 

Dr. Strong argues against the correctness of this doctrine, first, that it 
is based mainly on the belief of a revellant influence being exerted by 
the fistula, while an enlightened pathology and clinical observation teach 



290 Miscellaneous. 

that such an influence is of little or no value in preventing: or retarding 
the progress of pulmonary tuberculosis ; second, other and "kindred affec- 
tions, scirrhus aud melanosis, depending alike on a blood dyscracy, are 
not affected generally by revellent or derivant discharges ; third, the 
doctrine originated when erroneous views prevailed respecting the causes, 
nature, and management of tubercular affections. 

Conceding that tubercular matter is discharged, as it were vicariously, 
by means of the fistula, he contends that the proper object for therapeu- 
tics in this affection is not to eliminate the material, but to remedy the 
dyscrasy, by removing the condition on which it depends. — [Buffalo 
Med. Journal. 



Discovery of the Tomb of Hippocrates. — The JEsperance of Athens 
states, that near the village of Arnaoutli, not far from Pharsalia, a tomb 
has just been discovered, which has been ascertained to be that of Hip- 
pocrates, the great Physician, an inscription clearly enunciating the fact. 
In the tomb a gold ring was found, representing a serpent — the symbol 
of medical art in antiquity — as well as a small gold chain attached to a 
thin piece of gold, having the appearance of a band for the head. There 
was also lying with these articles a bronze bust, supposed to be that of 
Hippocrates himself. These objects, as well as the stone which bears 
the inscription, were delivered up to Housin Pasha, governor of Thessaly, 
who at once forwarded them to Constantinople. — [Late Foreign paper. 



A Compliment to the Doctors. — Dr. Jackson, the elder, of Boston, 
meeting his old friend Josiah Quincy, (both past eighty years of age,) 
on the side-walk, accosted him with, " Well, Mr. Quincy, how much lon- 
ger do you intend to live?" "Till I send for a doctor," was the quick 
reply. "And when rid you send for one, last?" inquired Dr. J. "Just 
eighty-six years ago !'-' answered Mr. Quincy, adding the precise date of 
his birth. 



A young man in Georgetown, D. C, who last week took four grains of 
Strychnine for the purpose of committing suicide, was saved by the inha- 
lation of an ounce and a half of Chloroform. Either of the doses would 
have killed him separately — between them both, he lived. — [Druggist's 
Circular. 



Glycerine. — Dr. Cotton, of Brompton Hospital, has employed this ar- 
ticle exclusively, and testifies against its efficiency in phthisis, pronouncing 
it greatly inferior to cod-liver oil. — [American Med. Gazette. 

Sup>ra-renal Capsules. — The cogenital absence of these organs has 
been found in a man, who always had a white skin, lived up to 40 years, 
and died of a malady of the chest. He worked as a joiner, was married, 
and had three sons. (See Glasgow Med. Journal for July last.) — Ibid. 

Value of a Young Lady's Teeth. — The Paris courts value a young 
lady's teeth at 8,000 francs. An English governess was recently knock- 
ed down by a carriage, and lost by the accident all her teeth. She 
brought on an action of damages, and the tribunal awarded that amount. 



SOUTHERN 

MEDICAL AND SURGICAL JOUMAL. 

(NEW SERIES.) 

Vol. XIV.] AUGUSTA, GEORGIA, MAT, 1S58. [No. f. 

ORIGINAL AND ECLECTIC. 

ARTICLE XII. 

Case of Diabetes Mellitus. Treated by Joseph Jones, A.M., M.D., 
Professor of Physics and Natural Theology in the University 
of Georgia, Athens ; Professor of Chemistry and Pharmacy in 
the Medical College of Georgia, Augusta ; formerly Professor 
of Medical Chemistry in the Medical College of Savannah. 

Irish laborer, entered the Savannah Marine Hospital and Poor 
House, July 17th, 1857 : age 24 ; height 5 feet 7 inches ; light 
hair, blue eyes, scanty reddish yellow whiskers ; greatly ema- 
ciated — arms and legs resemble those of a skeleton; ankles 
cedematous. Weight, in health, 140 lbs. ; now, it cannot be 
more than 90 lbs. 

Complained of continued pain in his head and bones, loss of 
strength, a voracious appetite, insatiable thirst, disordered diges- 
tion and a continued and exhausting diarrhoea. 

Had no fever and no enlargement of liver or spleen. Upon 
physical exploration the action of the heart and lungs appeared 
to be normal. 

The attempt was made to arrest the diarrhoea. Hope's mix- 
ture produced a temporary effect, but did not arrest the waste of 
tissue. Opium, chalk mixture, and the usual remedies for diar- 
rhoea were administered. They checked the diarrhoea tempora- 
rily, but did not arrest the waste of tissue and loss of muscular 
and nervous force. 

His diet was strictly guarded. It was found that the greater, 
portion of the meat which he ate, passed entirely through the ali- 

N. 6. VOL. XIV. NO. V. 13 



292 Jones, on Diabetes Mellitus. U&&J, 

mentary canal, and was voided in the form of fetid undigested 
masses. 

The patient was placed upon farinaceous diet — arrow -root, 
rice, and boiled milk and rice. Under this regimen, the stools 
became less numerous, and improved in appearance, but the 
destruction of tissue and loss of power was not arrested. 

External applications had no effect whatever upon the pain 
in his head and limbs. Strychnia, in small doses, failed to 
strengthen his digestive apparatus and nervous system. 

This treatment was continued for three weeks, and during this 
time his progress was steadily downwards. His tissues continu- 
ed to waste away, and his strength every day grew less. 

August 7th. Pulse 70. ) Temperature of Atmosphere, 81°F. 
V " " Hand, 96J° 

Kespiration 19. ) " under Tongue, 100° 

August 8th. Pulse 64. ) Temperature of Atmosphere, 81°F. 
I " " Hand, 97 i° 

Eespiration 18.) " under Tongue, 100° 

Examination of Urine. — Keaction slightly acid. 
Specific gravity 1040. 
Of a light straw color, clear limpid, resembling the urine of 
a female suffering with hysteria. The resemblance extended 
only to the color and amount passed, The high specific 
gravity of the urine of this patient, at once distinguished it from 
the abundant light colored urine often passed by hysterical 
females. The amount of urine passed by this patient during the 
24 hours varied from one to one and a half gallons — an enor- 
mous quantity, considering his reduced state, and the large 
amount of solid matters held in solution in the urine. 

Trommer's, Moore's, and the fermentation tests and the rapid 
formation of the Torula Cerevisiae, gave unequivocal evidence 
of the presence of grape sugar in large amount. 

Chemical analysis showed that the specific gravity of the urine 
was due, in great measure, to the large amount of grape sugar 
which it held in solution. 

Examination of Blood. — Specific gravity of Blood, . . 1043*2 
Specific gravity of Serum, . . 1022 # 2 
Coagulation of the blood commenced in a few minutes after it 
was drawn, and the clot was firm. 



1858.] 



Jones, on Diabetes Hellitus. 



293 



Under the microscope, the colored corpuscles were normal in 
color and form. They had a great tendency to stick together 
and form rolls, as in the blood of inflammation, and in the blood 
of the horse. 

This phenomenon resembled, in all respects, that which oc- 
curs in well marked cases of inflammation. 

The colorless corpuscles appeared to be deficient in numbers. 

Serum of a light straw color. When the serum was mixed 
with an equal quantity of water, and treated with a few drops of 
hydrochloric acid, sufficient to neutralize its alkaline reaction, 
no coagulation took place, even after prolonged boiling. 

Nitric acid produced prompt coagulation of the albumen of 
the serum. 



WATER 

In 1000 parts of Blood, 838*510 
" " " " Serum, 922-341 
(l) u " " " Liquor 

Sanguinis, - - 919*039 
(2)" 1000 parts of Liquor 

Sanguinis, - - 887*339 



SOLID MATTERS 
In 1000 parts of Blood, 161*490 
" " " " Serum, 77*659 
(1)" " " " Liquor 

Sanguinis, - - 80*961 
(2)" 1000 parts of Liquor 

Sanguinis, - - 112*661 



FIXED SALINE CONSTITUENTS 

In 1000 parts of Blood, 9*061 

u « u » Serum, 5*319 

(1} " " " " Liquor Sanguinis, 5*325 

(2) " " " " Liquor Sanguinis, 7*181 

" Blood Corpuscles of 1000 parts of Blood, 4*443 

" 1000 parts of Dried Blood Corpuscles, 47*916 

" " " " Moist Blood Corpuscles, 11*981 

" " " " Dried Residue of Blood, ------ 56*108 

" " " " " " " Serum, -<---- 68*488 

(1) " " " " " " " Liquor Sanguinis, - - 68*493 

(2) " " " " " « « Liquor Sanguinis, - - 63*739 
" Solid Matters of Serum of 1000 parts of Blood, - - - 4*519 

1000 Parts of Blood Contained 

Water, 838*510 

Dried Blood Corpuscles, 92*702 i !? riec J °W** **»* § ' 8 ^9 

1 ) b l.xed Saline Constituents, - 4*443 

Fibrin, -_.... 2*806 

Albumen 40 539 1 Dlied 0r £ anil - Matters, - 48*157 

j Fixed Saline Constituents, - 1*382 

Extractive Matters,- - 16-003 1 ^P 1 ?™'' "£■* " 1 J«J! 

[ Fixed Saline Constituents, - 3*137 



294 Jones, on Diabetes Mellitus. [May, 

1000 Paets of Blood Contained 

.) Water 278-106 

Moist Blood Corpuscles, 370-808 V Dried Organic Residue, - 88-259 

) Fixed Saline Constituents, - 4-443 

^ Water, - - - - 560-404 

Ait ) Dried Organic Residue, - - 48*157 

Liquor I DUmen ' j Fixed Saline Constituents, - 1-382 

Sanguinis, 629-192 f Extractive and ) Dried Organic Matters, 12-866 

Coloring Matt'rs, j Fixed Saline Constituents 3-137 

Fibrin, 2-606 

1000 Parts of Moist Blood Corpuscles Contained 

Water, 750-001 

Dried Organic Matters, --- 238-018 

Fixed Saline Constituents, 11-981 

(1) 1000 Parts of Liquor Sanguinis Contained 

Water, - 919-039 

Albumen .... 59-737 l Organic Residue, - - - 58-110 

' ) Fixed Saline Constituents, - 1-620 

Extractive and Coloring ) Organic Residue, - - - 13-670 

Matters, - - - - 17-345 j Fixed Saline Constituents, - 3-682 

Fibrin, 3*302 

(2) 1000 Parts of Liquor Sanguinis Contained 

Water, 886-740 

ah, ho ^00 ) Organic Residue, - - - 76*537 

Albumen, . - - - 78- ,33 J- Fix s ed Saline Con ^ ituents> . 2 -196 

Extractive and Coloring ) Organic Residue, - - - 24*484 

Matters, - - - - 29*469 ) Fixed Saline Constituents, - 4*985 

Fibrin, 4-459 

The method of analysis employed in these investigations has 
been described by the author (') in his Inaugural Dissertation for 
the degree of M. D. in the University of Pennsylvania, and in 
his Chemical ( 2 ) and Physiological Investigations, published by 
the Smithsonian Institution, and is similar in many respects to 
that employed by MM. Becquerel ( 3 ) and Eodier, Bowman, ( 4 ) 
and others. ( 5 ) 

(1) Physical, Chemical and Physiological Investigations, upon the Vital Phe- 
nomena, Structure, and Offices of the Solids and Fluids of Animals. By Joseph 
Jones. (American Journal of Medical Sciences, July, 185G, p. 46. 

(2) Investigations, Chemical and Physiological, relative to certain American 
Vertebrata. By Jos. Jones. Smithsonian Contributions to Knowledge. 1856. 

(S) Pathological Chemistry, by MM. Becquerel and Rodier. Translated by 
S. T. Speer, M. D. London : 1857, p. 19, et. sq. 

(4) Bowman's Medical Chemistry, pp. 145-194. Philadelphia : 1850. 

(5) Simons Chemistry of Man, p. 142. Philadelphia: 1846. Lehmann's Physi- 
ological Chemistry. Translated by G. E. Day. Cavendish Society pub. vol. ii., 
pp. 153-280. London. 1851-1854. See also American ed., edited by Prof. 
Rogers, vol. 1, pp. 541-648. Manuals of Blood and Urine. By Griffith Reese 
andMarwick. Philadelphia: 1848. 



1858.] Jones, on Diabetes Mellitus. 295 

All physiological chemists have failed to ascertain with abso- 
lute accuracy the amount of solid matter in the serum of 1000 
parts of blood. 

The proportion by which this is determined, although the 
closest approximation to the truth that can be made in the pre- 
sent state of science, is founded upon the erroneous assumption 
that all the water of the blood exists in the liquor sanguinis. 
C. Schmidt has shown that three-fourths of the colored blood 
corpuscles are composed of water. Hence, to obtain the relation 
of the moist blood corpuscles to the liquor sanguinis, we must 
multiply the dried residue of the corpuscles by 4. 

Physiological chemists possess no method by which the blood 
corpuscles can be determined with absolute accuracy. 

It is evident, from these facts, that when we attempt to calcu- 
late the moist blood corpuscles and liquor sanguinis of 1000 
parts of blood, whatever error entered into the calculation of the 
solid matters of the blood corpuscles, will be increased four fold, 
whilst the error in the calculation of the constituents of the 
liquor sanguinis will increase, not only in a direct ratio to the 
errors in the calculation of the blood corpuscles and solid mat- 
ters of the serum of 1000 parts of blood, but also in a definite 
ratio to the actual increase or decrease in the 1000 parts of moist 
blood corpuscles. That error exists in this method of analysis 
is rendered evident when we calculate the constituents of 1000 
parts of liquor sanguinis, from the data obtained by subtract- 
ing the moist blood corpuscles from 1000 parts of blood, and 
considering the remainder liquor sanguinis. 

The results thus obtained do not correspond with those 
obtained from the actual analysis of 1000 parts of liquor san- 
guinis. 

To render this error evident in the present method of analysis, 
I have in this and subsequeut analyses, stated the actual an- 
alysis of 1000 parts of liquor sanguinis, and that calculated 
from the constitution of the liquor sanguinis determined in 1000 
parts of blood, by the subtraction of the moist blood corpus- 
cles. 

The former, by actual experiment, is always marked (1) ; the 
latter, by calculation, is always marked (2). 

We will now compare this analysis of the blood of our diabetic 



296 



Jones, on Diabetes Mellitus. 



[May, 



patient with — 1st, analyses of normal blood, and 2nd, with 
analyses of abnormal blood. 

The following is given by Lehmann,( 6 ) as the standard con- 
stitution of healthy human blood. 



1000 Parts of Moist Blood Cor- 
puscles contain 

Water, 688-000 

Solid Constituents, - - 312-000 
Specific Gravity, - - -1088-5 

Haematin, 16-750 

Globulin & Cell Membrane, 282-220 

Fat, 2-310 

Extractive Matters, - - 2-600 
Mineral Substances with- 
out Iron, - - - - 8-120 



1000 Parts of Liquor Sanguinis 

contain 
Water,- ----- 902-900 

Solid Constituents, - - 97-100 
Specific Gravity, - - - 1028- 

4-050 
78-840 
1-720 
3-940 
8-550 



Fibrin, 

Albumen, - - - - 

Fat, 

Extractive Matters, - 
Mineral Substances, - 



The following are the physiological limits of the variations of 
the constituents of the blood, as established by the researches of 
MM. Becquerel ( 7 ) and Kodier. 



In 1000 F 


'arts 


OF 


Blood, 






The Water may vary - - - 






from 


760-000 to 


800-000 


" Specific Gravity of the Blood 
" Globules 


may vary 


" 1055- 


1063- 


u 


u 


u 


120-000 " 


150-000 


" Fibrin - 


u 


u 


u 


2-000 " 


3-500 


" Solid Matters of the Serum 


u 


u 


u 


90-000 " 


105 000 


" Cholesterine - 


u 


u 


u 


0-075 " 


0-150 


" Animal Soap, 


u 


a 


u 


1-000 " 


2-000 


" Serolin - 


<i 


M 


u 


0-010 " 


0-030 


" Chloride of Sodium 


u 


U 


u 


2-000 " 


5-000 


" Soluble Salts 


a 


u 


a 


1-500 " 


4-000 


" Phosphates - 


a 


u 


u 


0-500 " 


1-000 


In 1000 Parts 


OF 


Serum, 






The Specific Gravity of the Serum 


may var) 


' from 1027- to 


1032- 


" Water of the Serum - 


M 


u 


u 


880-000 " 


900-000 


" Solid Matters - 


U 


u 


u 


100-000 " 


120-000 



Albumen - 



70-000 



90-000 



The following is the typical formula of the constitution of the 
blood in health, adopted by MM. Becquerel( 8 ) and Kodier: 



(6) Lehmann's Physiological Chemistry, English ed., p. 160, vol. ii. American 
ed., p. 546, vol. i. 

(7) Pathological Chemistry of MM. Becquerel and Kodier, English ed., p. 90. 

(8) Pathological Chemistry, by MM. Becquerel aud Rodier. Eng. ed., p. 81. 



1858.] 



Jones, on Diabetes Mellitus. 



297 



Analysis of 1000 Parts of Serum. 

Specific Gravity of Se- 
rum, 1028-000 

Water, 908*000 

Albumen, - - - - 80-000 

Extractive Matters and 

Free Salts, - - - 12-000 



Analysis of 1000 Parts of Blood. 
Specific Gravity of the 

Blood, 1060-000 

Water, 781-600 

Globules, 135-000 

Albumen, 70-000 

Fibrin, - 2-500 

Fatty Matters, Extractive 

Matters & Free Salts, - 10-000 
Phosphates, - - - - 0*550 
Iron, 0-350 



If we carefully compare the analysis of the blood of our pa- 
tient with these analyses of normal blood^we will find — 

1. The specific gravities of the blood and serum are much 
lower than the normal standard. 

2. The colored corpuscles are diminished in numbers, the 
dried corpuscles being only 92*702, and the moist blood corpus- 
cles 370*808, whilst in health the dried corpuscles generally 
average 135*000 and the moist corpuscles 540*000. 

3. The albumen of the liquor sanguinis is much less than 
normal, being only 49*539 in the 1000 parts of blood, whilst » 
in health, it ranges from 70 to 90. 

4. The extractive and coloring matters are 12*866, and are 
greater in amount than normal. When we compare the ex- 
tractive matters with the diminished albumen and blood corpus- 
cles, it is evident that they are far more abundant than normal. 

5. The fixed saline constituents are normal in amount as 
compared with normal blood, but increased when compared 
with the diminished albumen and blood corpuscles. 

It is important that we should, in the next place, compare the 
blood of this patient, reduced in flesh and strength to the last 
degree, with the blood of individuals whose blood has been 
depraved, and forces exhausted by other diseases. 

The following examples, are selected from numerous analyses 
of the blood of patients suffering with malarial fever, which I 
conducted in the Savannah Marine Hospital and Poor House, 
during the last summer and fall : — 

Case I. Intermittent Fever, neglected. — Irish laborer, entered 
the Savannah Poor House Sept. 23rd : age 22 ; height 5 feet 8 
inches. Had been working in the marshes along the Savannah 



298 



Jones, on Diabetes Mellitus. 



[May, 



river, and suffered with chill and fever for two months, during 
which time he had no medical attendance. Complexion sallow ; 
tongue, lips and gums pale; digestion impaired. Complains of 
great weakness. Flesh not much redtfced, but feels soft and 
unnatural. 

Examination of Blood. — Blood watery in appearance — coagu- 
lated slowly in 30 minutes. Eeaction decidedly alkaline. In 
the specific-gravity-bottle filled with blood, the colored corpus- 
cles gravitated towards the bottom and left above a light yellow 
transparent clot. After standing 20 hours, the clot had con- 
tracted but little, and its consistency was very weak. Serum, 
of a light yellow color. 

Specific Gravity of Blood, - - - - 1030*5 
Specific Gravity of Serum, .... 1021-3 



WATER 

In 1000 parts of Blood, 877-553 
" « " « Serum, 927-757 

(1) « » « « Liquor 

Sanguinis, - - 925-725 

(2) "1000 parts of Liquor 

Sanguinis, - - 911-124 



SOLID MATTERS 
In 1000 parts of Blood, 122-447 
" " " "Serum, 72-243 
(1)" " « "Liquor 

Sanguinis, - - 74*275 
(2) "4000 parts of Liquor 



Sanguinis, 
" in Serum of 1000 
parts of Blood - 



88-876 
68-435 



(1) 
(2) 



(1) 
(2) 



FIXED SALINE CONSTITUENTS 
In 1000 parts of Blood, .... 
" " " Serum, 
" " " Liquor Sanguinis, - 
» " " Liquor Sanguinis, - 
Serum of 1000 parts of Blood, - 
1000 parts of the Solid Matters of Blood, 
" " Serum, 
" " Blood Corpuscles, 
" " Liquor Sanguinis, 
" " Liquor Sauguinis, 
" Blood Corpuscles of 1000 parts of Blood, 
" 1000 parts of Moist Blood Corpuscles, 



N <i 

U U 



3 
3 
3 

3 
27 
45 

3 
44 
44 







1000 Parts of Blood Contained 
Water, 

Dried Blood Corpuscles, 51 987 



Fibrin, 

Albumen and Extractive 
and Coloring Matters, 



68-335 



877- 
Dried Organic Residue, 51- 
Fixed Saline Constituents, 0' 

I- 
Dried Organic Residue, 65* 
Fixed Saline Constituents, 3' 



316 
326 
328 
965 
141 
083 
901 
240 
779 
612 
175 
841 



553 
812 
175 
925 
194 
141 



1858.] Jones, on Diabetes Mellitiis. 299 

1000 Parts of Blood Contained 

\ Water, ... 155 861 

Moist Blood Corpuscles, 207 948 V Organic Residue, - 51-612 

) Fixed Saline Constituents, 0-175 

1 Water, - - - 721-692 
| Albumen and Extractive 
Liquor Sanguinis, - 792-052 \ and Coloring Matters, 65-194 

I Fixed Saline Constituents, 3-141 
J Fibrin, - - - 1-925 

1000 Parts of Moist Blood Corpuscles Contained 
Water, --.-----. 749-51S 

Dried Organic Matters, - 249-154 

Fixed Saline Constituents, 0-841 

(1) 1000 Parts of Liquor Sanguinis Contained 

W T ater, 925-725 

Albumen, Extractive and Coloring Matters, - - • 68-817 

Fibrin, -.------- 2-032 

Fixed Saline Constituents, - - • - - - 3-326 

(2) 1000 Parts of Liquor Sanguinis Contained. 
Water, .-----.-- 911-167 
Albumen, Extractive and Coloring Matters, - - - 82-312 

Fibrin, ..-..•-.• 3-965 

Fixed Saline Constituents, ------ 2-430 

The urine of the patient was of low specific gravity, dimin- 
ished in amount, and contained no grape sugar. 

Case II. Intermittent Fever, neglected — terminating in Bilious 
Remittent Fever, and complete alteration of the Chemical Constitu- 
tion of the Blood and Tissues. 

German Butcher, entered the Savannah Poor House Sept. 
25th : age 23 ; height 5 feet 10 inches ; weight, in health, 
180 lbs. 

His present weight cannot be more than 110 lbs. Has been 
suffering with chill and fever for two months, and has had no 
medical attendance. Sallow, anaemic complexion; flesh and 
strength greatly reduced; nervous and muscular forces very 
feeble. Was brought into the Hospital in a comatose state. 

Stimulants, sinapisms, cut cups to the temples and back of 
neck, and blisters to the epigastrium and back of neck, aroused 
him from this comatose condition. 

A few days after his entrance into the hospital, a large abscess 



300 Jones, on Diabetes Mellilus. [^aj, 

formed upon the side of his head, in - the region of the ear, and 
joint and angle of the inferior maxillary bone. 

Notwithstanding that this abscess was lanced, the pus formed 
an entrance into the external meatus auditorius. 

Large masses of the cellular tissue and muscles sloughed 
away, and the angle and superior portion of the inferior maxil- 
lary bone were almost completely stripped of flesh. The abscess 
compelled him to lie upon the opposite side of his body, and 
the arm upon which the weight of the body rested swelled enor- 
mously, until it appeared to be ready to burst, and finally the 
skin over the biceps muscle changed to a black color, and 
sloughed off in a single night, leaving the red quivering mus- 
cles entirely exposed. 

The biceps muscle sloughed entirely off from its lower attach- 
ment. Large ulcers appeared in various parts of his body. 

The patient lingered, supported by tonics, nutritive diet and 
stimulants, for three weeks. 

After death, his liver presented a color a shade lighter than 
the slate color of the malarial fever liver, and in many parts it 
was regaining its normal hue. The spleen was enlarged and in 
many parts completely degenerated in structure, being convert- 
ed into pus and a substance resembling cheese. The surface of 
the spleen was covered with effused coagulable lymph, and 
bound to the liver by bands of coagulable lymph. The border 
next to the liver contained an abscess about the size of a wall- 
nut, filled with pus. The whole substance of the spleen was 
consolidated, and those portions which were not degenerated, 
resembled, when cut, the liver of malarial fever. The stomach 
showed the marks of chronic inflammation. 

The glands of Peyer, in the lower portion of the intestinal 
canal, were enlarged, but pale, and not more congested with 
blood than usual. 

Examination of the Blood of this patient four days after his en- 
trance into the Hospital. — Blood coagulated slowly. In one spe- 
cimen, the coagulation was remarkably slow, and the blood 
corpuscles gravitated towards the bottom of the vessel and left 
above a clear, golden colored clot. This transparent portion of 
the clot was about I of an inch in thickness. 

Serum, of a deep golden color. Eeaction of serum, alkaline. 



1858.] 



Joxes, o/i Diabetes Mtllitus. 



301 



Specific Gravity of Blood, 
Specific Gravity of Serum, 



1036-6 
1023-6 



WATER 
In 1000 parts of Blood, B40-511 
" " " »• Serum, 913 950 
(1)" " ■« "Liquor 

Sanguinis, - - 912 665 
(2) " 1000 parts of Liquor 



Sanguinis, 



882-723 



SOLID MATTERS 
In 1000 parts of Blood, 159*489 
" " " " Serum, 86-050 
(1)" " M "Liquor 



;anguinis, - - 



86-973 



(2)" 1000 parts of Liquor 

Sanguinis, • - 117 '27 7 
Solid Matters of Serum of 

1000 parts of Blood, 79-135 



(1) 
(2) 



(1) 
(2) 



FIXED SALINE CONSTITUENTS 

In 1000 parts of Blood, - 
* " Serum, - 
u " Liquor Sanguinis, - 
" " Liquor Sanguinis, - 
' " Solid .Matters of Blood, 
' " M " ■• Serum, 

" " " " " Liquor Sanguinis, 

I " " " •• Liquor Sanguinis, 

II " M M " Blood Corpuscles, 
" " Moist Blood Corpuscles, - 

Blood Corpuscles of 1000 parts of Blood, 
" Serum of 1000 parts of Blood, - 



5-796 

2-647 

2-653 

3-493 

36-341 

30-178 

30-205 

29-850 

42-914 

10-723 

3-409 

2-357 



1000 Parts of Blood Co>-tai:ved 
Water, --.------. 

-rv ■ j t»i jp i ~c\ A*>-t ) Dried Organic Residue, • 

Dried Blood Corpuscles, 79-43/ > „. , ^ ?. n ... ' 

r $ rixed Valine Constituents, 

Fibrin - 

Albumen, Extractive and > Dried Organic Residue, - 

Coloring Matters, - 79-096 V Fixed Saline Constituents, 



840-511 

76-023 

3-409 

0-877 

76-703 

2-387 



1000 Parts of Blood Contained 
Moist Blood Corpuscles, 317-748 



} Water, 

18 V Dried ( 

) Fixed \ 



Organic Residue, - 
Saline Constituents, 



1 Water, - 
Dried Organic Residue, - 
Fixed Saline Constituents, 
Fibrin, - 



238-271 

76-028 

3.409 

602-240 

76-708 

2-387 

677 



1000 Parts of Moist Blood Corpuscles Cotalxed 
Water, .---•-..-. 749-873 
Dried Organic Residue, ...... 239-284 

Fixed Saline Constituents, ..-.-. 10-728 



302 



Jones, on Diabetes Mellitus. 



[May, 



(1) 1000 Parts of Liquor Sanguinis Contained 
Water, -...--.-. 913-022 
Albumen, Extractive and Coloring Matters, . - - 83-303 

Fixed Saline Constituents, - i - - - - 2-647 

Fibrin, - - 0-928 



(2) 1000 Parts of Liquor Sanguinis Contained 
Water, ...---.-- 882-723 
Albumen, Extractive and Coloring Matters, - - - 112-433 
Fixed Saline Constituents, ------ 3-498 

Fibrin, .--.---.. 1-285 

Case III. Bilious Remittent Fever. — American Seaman, na- 
tive of Boston, entered the Savannah Marine Hospital Sept. 
26th : age 21 ; weight 150 lbs. ; height 5 feet 10 inches. Mus- 
cular system moderately well developed. 

This is his first trip to Savannah. Has been sleeping at night, 
on the deck of the ship in the open air. The captain compelled 
all his men to sleep on board the ship, which was lying along 
the low marshy shore below the city. 

This patient was brought in comatose, and has been passing 
his urine and feces in bed. 

Sept. 29th. Jjies in a stupor ; complexion sallow ; teeth coat- 
ed with sordes; tongue perfectly dry and as rough to the feeling 
as the surface of a newly sawed board. Pulse 120 ; Eespira- 
tion 22. 

Examination of Blood. — Blood coagulated slowly. Serum, of 
a deep golden color. 

Nitric acid showed that this color was due to the presence of 
bile. 

Eeaction of serum, alkaline. 



Specific Gravity of Blood, 
Specific Gravity of Serum, 



1040 
1022 



WATER 

In 1000 parts of Blood, 833-449 
" « ii c< Serum, 912-386 
(1)" « « "Liquor 

Sanguinis, - - 910-798 
(2)" 1000 parts of Liquor 

Sanguinis, - - 875-813 



SOLID MATTERS 

In 1000 parts of Blood, 166-551 
u u u «( gerum, 87-614 

(1) " « « " Liquor 

Sanguinis, - - 89-203 

(2) "1000 parts of Liquor 

Sanguinis, - - 124-187 
"Serum of 1000 parts 

of Blood, - - 80-033 



1858.] 



JONES, on Diabetes Melliius. 



303 



FIXED SALINE CONSTITUENTS 

In 1000 parts of Blood, 
" Serum, 

" Liquor Sanguinis, 
M Liquor Sanguinis, 
" Dried Blood Corpuscles, 
" Moist Blood Corpuscles, 
" Dried Residue of Blood, 
" " « " M w Serum, 

Serum of 1000 parts of Blood, - 





U 


u 


(i 


(1) 


II 


H 


tl 


(2) 


m 


H 


M 




m 


M 


N 




u 


II 


II 




u 


II 


II 



6-314 
6*620 
6-630 
8-759 
6-595 
1-646 
37-909 
75-558 
5-747 



1000 Parts of Blood Contained 

Water, ......... S33-449 

Tk • j oi j n i o- nco ^ Dried Organic Residue, - 84-400 

Dr.ed Blood Corpuscles, 8o. 9 68 { Fixed £^ ConstitueMs, 0-567 

Fibrin, • . . . ... . . . 1-450 

Albumen, Extractive and ) Dried Organic Residue, - 74-1S6 

Coloring Matters, - 80-033 ] Fixed Saline Constituents, . 5-747 

1000 Parts of Blood Contained 

} Water, .... 258-804 
Moist Blood Corpuscles, 343-872 V Dried Organic Residue, - 84-400 

} Fixed Saline Constituents, - 0-567 
^ Water, - 574-646 

| Albumen, Extractive and 
Liquor Sanguinis, - - 656*128 J- Coloring Matters, - - 74-185 

| Fixed Saline Constituents, - 5-747 
J Fibrin, .... 1-450 

1000 Parts of Moist Blood Corpuscles Contained 
Water, .-.------- 752-646 

Dried Organic Residue, ------- 245-239 

Fixed Saline Constituents, ---... 1-648 

(1) 1000 Parts of Liquor Sanguinis Contained 
W T ater, ....... 910-797 

Albumen, Extractive and Coloring Matters, . - - - 80-996 
Fixed Saline Constituents, ------ 1-587 

Fibrin, - 6-620 

(2) 1000 Parts of Liquor Sanguinis Contained 

Water, - 875-813 

Albumen, Extractive and Coloring Matters, - - - 113-064 
Fixed Saline Constituents, ..-.-- 8-758 
Fibrin, - 2-209 



Lender the use of stimulants, sulphate of quinia, and nutri- 
tious diet, this patient recovered, slowly. He was confined to 
his bed three weeks, and at the end of this time, exhibited 



304 Jones, on Diabetes Mellitus. [May, 

the effects of the bilious remittent fever, in his pale, sallow, 
anaemic countenance, pale lips and gums, and tottering gate. 

The violent nature of the malarial fever, contracted by sleep- 
ing in the open air in the low marshy land bordering our fresh 
water rivers, is forcibly illustrated by the subsequent history of 
the crew to which this patient belonged. 

A few days after his admission into the hospital, the captain 
weighed anchor and sailed for New York. Before getting well 
out to sea, himself and the whole of his crew were taken sick. 
There was not a man with strength to work a pump or furl a 
sail. Fortunately a small vessel perceived their signals of dis- 
tress, and towed them into Darien. Before reaching this port 
the captain and five out of seven of the crew had died. There 
were but two remaining out of eight, and these were extreme- 
ly ill. 

If we compare the blood of these cases with that of health, 
and with the blood of the patient suffering with diabetes melli- 
tus, we will observe the following points of agreement and 
disagreement : 

1. The colored blood corpuscles are diminished greatly and 
rapidly in malarial fever. This destruction of the colored blood 
corpuscles is far more rapid in malarial fever than in diabetes 
mellitus. 

2. The salts of the colored blood corpuscles are diminished 
to a remarkable extent in malarial fever — whilst they are normal 
in amount in the blood of diabetes mellitus. 

3. The blood coagulates slowly, and the clot is soft, in mala- 
rial fever — whilst the reverse was the case in this specimen of 
diabetic blood. 

4. The fibrin is often diminished in malarial fever, and the 
serum presents a golden color — whilst in this case of diabetes 
mellitus the fibrin was slightly increased and the color of the 
the serum was normal. 

That the poison of malarial fever induces profound changes 
in the colored blood corpuscles, and other constituents of the 
blood, I have demonstrated by the following facts : 

(a). The urine of patients suffering with malarial fever con- 
tains an increased quantity of iron. The increase of the iron 
in the urine is subsequent to the destruction of the colored cor- 
puscles in the blood. 



1858.] JoXES, on DiuLetes Mellitus. 305 

(b). In examinations of the organs after death, from all the 
forms of malarial fever — intermittent, remittent and congestive — 
I have observed that the dark blood of the spleen and liver do 
not change to the arterial hue when exposed to the action of the 
oxygen of the atmosphere. 

After death from phthisis, cirrhosis of the liver, organic dis- 
ease of the circulatory apparatus, and apoplexy, and mechanical 
injuries, as far as my observations extend, the blood of the 
spleen and liver always change to the arterial hue when ex- 
posed to the action of the oxygen of the atmosphere. 

(c). Animal starch accumulates in the malarial-fever liver — 
whilst grape sugar, as far as my observations extend, is absent. 
I have tested the livers of malarial fever for grape sugar and 
starch. An abundance of starch ( 9 ) was obtained, without a 
trace of grape sugar. 

The livers were set aside, and examined after intervals of 
twelve hours. The last examination was made thirty-six hours 
hours after the first. At every examination the result was the 
same — an abundance of animal starch, and no grape sugar. 

These facts are important, not only in their bearing upon 
malarial fever, but also in their bearing upon diabetes mellitus. 
M. CI. Bernard ( ! °) has demonstrated that the transformation 
glycogenic hepatic matter (animal starch) formed by the liver, 
into glucose, is the result of the action of a special ferment, 
which is formed and exists in the blood, independent of the 
liver. 

From the facts which we have previously stated, it is evident 
that in malarial fever, this ferment is destroyed, whilst the liver 
still possesses the power of transforming the nitrogenized and 
non-nitrogenized elements into animal starch. 

We have now facts sufficient, to draw important distinctions 
between malarial fever and diabetes mellitus. 

(9) So abundant is this animal starch in the malarial fever liver, that if a small 
particle of the substance of the liver be mashed upon a glass slide, treated -with 
a saturated solution of iodine in alcohol, and viewed under the microscope, nu- 
merous beautiful blue masses ot this animal starch, colored by the iodine, will be 
seen. If the fibrous capsule be torn off from the surface of the liver, spread upon 
a glass slide, and treated with tincture of iodine, these blue masses will be seen 
scattered amongst the meshes of the fibrous tissue. With reference to the dis- 
covery of animal starch, see Ameriean Journal of Medical Sciences, Oct. 1857, 
p. 549. 

(10) Moniteur de Hopitaux, April 14, 1857 ; also, American Journal of Medical 
Sciences, July, 1857, p. 208 



306 



JONES, on Diabetes Mellitus 



[May, 



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1858.] Joxes, on Diabetes Meltitus. 307 



~\Ve have now all the necessary facts for the intelligent treat- 
ment of this case. 

The indications in the treatment of this case of diabetes melli- 
tus are — 

(1). To strengthen digestion. 

His stomach fails to digest the nitrogenized elements — the 
very substances which he needs, to supply the rapid waste of his 
tissues. 

(2). To afford the organic and inorganic materials of structure. 

(3). To quiet and strengthen the nervous system. 

(■i). To arrest the destruction and transformation of the ele- 
ments of the blood, tissues and food, into animal starch and 
grape sugar. 

(1). To strengthen Digestion. — Meat passed entirely through the 
alimentary canal, without being digested. This is clear evi- 
dence that the gastric and pancreatic juices do not perform their 
offices. The active and essential principle of the gastric j uice 
being pepsine. this must first be supplied. If pepsine and an acid 
be supplied, digestion will take place in a weak, diseased stom- 
ach, as well as in the healthy stomach. The truth of this asser- 
tion has been established by the experiments of Dr. L. Corvisart 
of Paris, ( T l ) to whom the profession is indebted for the intro- 
duction of pepsine into the practice of medicine. 

Andral, Longer, ( 12 ) Billet, Barthez, ( 13 ) Grisole, Herard, 
Togel, Schiff, Josi, Lecointe, ( ,4 ) Ballard, ( 15 ) Bertholet, ( 16 ) 

(11) "Dyspepsie et Consomption — usage de la Pepsine," by Dr. L. Corvisart. 
Paris, IS 54. 

" Recherches ayant pour but, d'administrer aux malades qui ne digerent point 
des aliments tours diffires par le sue gastrique des animaux/' Comptes Rendus, 
Aug. 16th, 1S52— Sept. 6th, 1S52. 

Etudes sur les Aliments et Nutriments — Xouvelle Methode pour le traitement 
des malades dont l'estomac ne digere point." — L'Union Medicale, 1854, p. 17. 

(12) In typhoid fever. — Bulletin Gen. de Therap. t xlvil p. 320. 

(13) Sur Tapepsie (on absence de digestion) chez lezenfans. et sur le traitement 
de cette maladie par la pepsine. — L'Union Medicale, Jan. 12th, 1S56. 

(14) Observation d'un cas de consomption ultime, traitee par la Poudre Xutri- 
mentive, — Bulletin Gen de Therap. L xlix. p. 268. 

(15) Artificial Digestion as a Remedy in Dyspepsia, Apepsia, and their resulta. 
By Edward Ballard, M.D., London, 1857. This valuable work contains the me- 
thod of preparing the pepsine. and also the report of numerous cases of disordered 
digestion, successfully treated with pepsine, by Dr. Ballard and other practitionere 
of medicine. 

(16) In Dyspepsia of a year's duration. 

13* 



308 Jones, on Diabetes Mellitus. [May, 

Cahagnet, (' 7 ) Parise, ( l 8 ) Huet, (' 9 ) Chambers,( 2 °) Nelson ( 2 *) 
and others, ( 2 2 ) have testified to the efficacy and value of pepsine 
in various diseases. 

The fourth stomach of ruminants (rennet bag) is generally 
recommended as a source of pepsine. In hospital practice, how- 
ever, I preferred to employ the stomach of the pig, for two 
reasons : 

The pig is an omniverous animal. Its food and digestive 
process resembles more nearly that of man, and consequently 
its gastric juice must be better adapted to his wants. 

For hospital purposes, the stomach of the pig can be much 
more readily obtained and prepared, than that of the cow or 
sheep. 

When pepsine can be obtained pure from the apothecaries, or 
when the physician has time to prepare it himself, the Poudres 
Nutrimentives ( 2 3 ) of Corvisart is by far the most elegant and 
portable preparation. 

(1*7) In Dyspepsia and Vomitings of several years' duration. 

(18) In Dyspepsia of early Pregnancy. 

(19) Gastralgia after food of several years' duration. 

(20) Practical Lectures on the Management of Digestion in Disease, by T. K. 
Chambers, M.D.— London Lancet, Aug., 1857, p. 101— Sept. 1857, p. 180, Am. Ed. 

(21) On Mellitic Diabetes in reference to its Treatment by Rennet or Liquor 
Pepticus Prsep., by David Nelson, M.D. — London Lancet, Aug. 1857, p. 118, Am.. 
Edition. 

(22) Rennet in Diabetes Mellitus, by Dr. James Gray. — Glasgow Med. Journal, 
Oct. 1856. See also American Journal of Medical Sciences, Jan. 1857, p. 2 5. 

(23) The following are the directions, given by M. Boudalt, for the preparation 
of the medicine : — "Take a sufficient number of rennet bags (the fourth stomach 
of the ruminants), open and reverse them, and wash them under a thin stream of 
cold water ; scrape off the mucous membrane, reduce it to a pulp, and macerate it 
in distilled water for twelve hours ; filter ; add to the liquor a sufficient quantity 
of acetate of lead, and after separating the precipitate, pass through it a current 
of sulphuretted hydrogen ; filter again ; evaporate at a low temperature to the 
consistence of a syrup, which is mixed intimately with starch pulverized, and 
dried at a temperature of 100° centig. In this state the gentle application of heat 
will reduce it to a dry mass re'adily reducible to a powder of uniform efficacy. " 

The power of the pepsine thus obtained, varies, and before the use of a speci- 
men, we should first test its transforming power. The standard dose is that quan- 
tity of the powder, which when acidulated with three drops of lactic acid and 
added to 15 grammes (225 grains) of water, would transfer 6 grammes (90 grs.) 
of fresh fibrin finely cut up, and kept in a bottle, at a temperature of 40° centig. r 
for twelve hours, with occasional shaking. The average dose of the "Poudre 
Kutrimentive" is 15 grains. It may be taken dry or in solution, in unfermented 
bread, or in a spoonful of soup, or in sweetened water. It should always be ta- 
ken with, or at the commencement of the meal on which it is to act. — Ballard on 
Artificial Digestion, p. 10. See also, Memoire sur le principe digestif, les prepa- 
rations nutrimentives, et les moyens propres a reconnaitre et a mesurer leur ac^ 
tion. — Acad. Imp. de Med., Seance du 14 Fevrier, 1854, et Moniteur des Hopitaux, 
16 Fevrier, 1854. 



1858.] Jones, on Diabetes Mellitus. 309 

*$. Cut a pig's stomach into thin slices, and pour upon it 
one pint of vinegar, and preserve from decomposition (if the 
weather be warm), by surrounding with ice. 

The pepsine and vinegar will reduce the tissues of the stom- 
ach to a uniform mass, or rather, fluid. Dose, f 5j. three times 
a day, mixed with cold mutton or beef soup. 

This preparation is useful for hospital purposes, because it is 
easily prepared, and at the same time is more efficacious than 
the pepsine ordinarily sold in the shops. 

Chambers^ 4 ) and other ( 25 ) have shown that much of the 
pepsine now sold, possesses but feeble transforming powers. 

Pepsine is not the only substance concerned in the digestion 
of albumenoid substances. 

The connective tissues and muscular fibres are disintegrated 
and softened, but never completely dissolved by the gastric juice. 

The ultimate fibrilla3 of muscles which have escaped the ac- 
tion of the gastric juice pass into the small intestines, and are 
there digested by the pancreatic juice. 

M. L. Corvisant( 2 6 ) communicated to the Imperial Academy 
of Sciences, April 6th, 1857, a Memoir on the Power of the 
Pancreas to Digest Azotized Food, in which he confirmed the 
assertion of Purkinge and Pappenheim, that the secretion of the 
pancreas is endowed, like the gastric juice, with the property of 

The following is the mode adopted and recommended by Dr. James Gray of 
preparing the rennet: 

" The stomach of a calf (and the younger it is the better,) is gently washed 
with water, taking care not to injure the mucous membrane; it is then salted, 
tied up and allowed to dry. After this, it is cut into small pieces, macerated in 
a pint and a half, or two pints of water, according to the size of the stomach, for 
four days or longer in winter, shaking it at intervals ; the fluid is then poured off 
and bottled, and to test its power, a spoonful may be added to a pint of warm 
milk, which, if it curdles, it is now fit for use. A little spirits, or decoction of 
sparrow-grass, may be added to make it keep. The dose of rennet thus prepared 
is a tablespoonful, three, four, or six times a day, about half an hour after each 
meal, and during the process of digestion, followed shortly after by an alkali, to 
neutralize the lactic acid formed. That which I recommend is the alkaline tri- 
basic phosphate of soda; but the carbonate of potash will answer very well, 
either alone or combined with the tincture of nux vomica, in five or ten drop 
doses." — Glasgow Medical Journal, Oct. 1856. See abstract of paper in Amer. 
Jour, of Medical Sciences, Jan. 1857, p. 215. 

(24) Experiments upon Artificial Digestion, by T. K. Chambers, M. D. London 
Lancet, Aug. 1857, p. 133, Am. ed. 

(25) Experiments upon the Action of Pepsine, by Edward H. Sieveking. Med. 
Times and Gazette, April 4, 1857. See, also, American Journal of Med. Sciences, 
26 July, 1857, p. 212. 

Monitenr des Hopitaux, April 21st, 1857. See, also, American Journal of Med. 
Science*, July, 1857, p. 206, 



310 Jones, on Diabetes Mellitus. [May, 

dissolving azotized food, and demonstrated that the pancreatic 
juice in disintegrating albumenoid elements, effects in them a 
transformation identical or analogous to that which the stomach 
produces. 

The pancreatic juice acts only on those portions of the food 
which have escaped the action of the gastric juice, and at the 
same time it has no effect upon the digested products of the 
stomach. 

When separated, the pancreatic and gastric fluids exercise 
their functions in full, and when mingled in their pure state, 
the two digestions are arrested. The two ferments, pepsine and 
pancreatine, destroy each other. 

In the alimentary canal, this is prevented. 1st, by the pylor- 
ous which separates the two ferments. 2nd, by the gastric 
digestion during which the pepsine is destroyed. 3rd, by the 
bile which destroys in its course the activity of the pancreatine. 

It is evident, therefore, that the pancreatine, or the pancreatic 
juice, so far from assisting digestion, would retard it. M. S. 
Corvisart states that he had failed to receive any benefit from 
the administration of pancreatine for the relief of derangement 
of the digestion in the intestinal canal. 

In this case of diabetes mellitus, I employed a preparation of 
the pancreas of the pig, prepared in the same manner with 
the stomach. No beneficial results were produced, and it was 
abandoned and the pepsine retained. 

(2.) To afford the organic and inorganic materials of structure. 

As usual in the treatment of diabetes mellitus, the patient was 
furnished principally with animal food — eggs, mutton, beef, &c. 

Bread and rice were allowed more frequently, however, than 
in the practice laid down in the books. 
$ Phospate of Iron, . . 
" a Lime, . . 
" Soda, . . 
" " Potassa, . " iv. 
Mix and administer three times during the day, in the soup 
containing the pepsine. These salts were given because they 
form important constituents of the blood corpuscles, muscles and 
brain, and nervous system. 

$ Cod-liver oil, tablespoonful three times a day. 



grs. 


1> 


u 


iv. 


u 


vi. 



1858.] Jones, on Diabetes Mellitus. 311 

Cod-liver oil is indicated in the treatment of diabetes mellitus 
for two reasons : 

To supply the fatty matters which have been consumed. 

There is a close connection between phthisis and diabetes. 

Writers upon this disease state that, in the majority of cases, 
phthisis makes its appearance before death. 

(3.) To strengthen and quiet the nervous system. 
The depressed spirits, fretful, peevish temper, impaired mem- 
ory and intelligence, loss of sexual propensity, and complete 
exhaustion of nervous power, call for those remedies which will 
act both as tonics and sedatives to the nervous system. 

To accomplish these objects, opium and strychnia should be 
given simultaneously. 

$ Strychnia, grs. ij. 

Extract of Gentian, . . . " 3 ij. 

Mix and divide into 100 pills; one pill three times a day, to be 
gradually increased, according to the strength of the patient 
and effects upon the nervous system. 

Strychnia not only exerts a tonic influence upon the digestive 
organs, and muscular and nervous systems, but also exerts a 
direct influence in diminishing the amount of sugar formed. 

# One grain of opium at bed-time, and one grain in the 
morning, at 9 o'clock. 

Opium quiets the nervous irritability of the patient, and con- 
trols the diuretic influence of the sugar in the blood. It checks 
the excessive discharge, but does not prevent the production of 
sugar. Nevertheless, its action upon the nervous system ren- 
ders it one of the most valuable of the secondary means. 

As a stimulant and tonic to the digestive organs, f I ij. of bran- 
dy were administered, three times a day, in a cup of the officinal 
infusion of quassia and soda. 

Aug. 10th. — Pulse, 74. Temperature of Atmosphere, 88° F. 

" under Tongue, 98° 

Aug. 11th. — Pulse, 78. Temperature of Atmosphere, 81° F. 
Eespiration, 16, " under Tougue, 99 J° 

August 12th. — Slight improvement of digestion. Bowels are 
not moved so frequently. He is exceedingly weak, and com- 
plains of pain in his head and bones. 



812 Jones, on Diabetes Mellitus. [May, 

August 19th. — Complains of great weakness and thirst; is in 
a profuse perspiration ; says that his digestion improves, but his 
strength does not increase. The brandy causes him to sleep 
and perspire too freely, and is probably the cause of the increas- 
ed flow of urine and loss of strength. 

The experiments of George Harley, M.D., ( 2 6 ) and M. Ber- 
nard, ( 2 7 ) have demonstrated that alcohol, ether, chloroform, 
methylated spirit, and ammonia, introduced into the duodenum, 
or injected directly into the portal vein, will excite an increased 
secretion of sugar. Healthy animals thus operated on were 
rendered for a time diabetic. This fact is important, not only 
in the treatment, but also in its bearing upon the causes of dia- 
betes mellitus. 

Drunkards are said to be peculiarly liable to this disease. 

Pulse 84, Eespiration 17, Temperature of Atmosphere, 90° F. 

" under Tongue, 104° 

The acceleration of the pulse may be due to the action of the 
alcoholic stimulants. "We will discontinue the brandy and sub- 
stitute 10 grains of carbonate of ammonia, three times a day, in 
a cup of the infusion of quassia and soda. 

The carbonate of ammonia is administered, first, as a stimu- 
lant, and second, as a means of diminishing the amount of grape 
sugar. 

Some chemists ( 2 8 ) have supposed that the occurrence of alka- 
line carbonates is necessary for the decomposition of sugar in 
the animal economy, and that in diabetes the passage of glucose 
into the urine is due to a want of alkalinity in the blood. 

(26) " Contributions to the Physiology of Saccharine Urine. On the Origin and 
Destruction of Sugar in the Animal Economy, by George Harley, M.D." — British 
and Foreign Medico-Chir. Review, July, 1857, p. 144. 

(27) Gazette Medicale de Paris, Mai 10, No. 19, 1856, and Schmidt's Jahrb., vol. 
xciii. p. 24, 1857. 

(28) Chimie applique a'la Physiologie et a la Therapeutique, Par M. le Docteur 
Mialhe, Pharmacien d' l'Empereur. — Paris, 1856. 

In this work, Mialhe, after examining the various hypotheses which have been 
proposed to explain the nature of diabetes mellitus, comes to the conclusion that 
its true cause is a deficiency of alkali in the blood. To the objection that the 
blood of diabetic patients is never either neutral or acid, but always alkaline in 
its reaction, Mialhe answers that it is difficult to determine the amount of the 
alkalinity of the blood; and again, that part of the alkaline reaction of this 
fluid is derived from the presence of alkaline phosphates which possess no power 
of decomposing glucose. He is inclined to consider that the alkaline carbonates 
are deficient or absent, the phosphates remaining intact, thus preventing the 
fluid from exhibiting anything but an alkaline reaction. 

In the treatment of diabetes he acts strictly u^on these indications, and pre- 



1858.] Jones, on Diabetes Mellitus. 313 

Direct experiment does not supp*::; this theory, for the re- 
searches of C. G. Lehmanri, ( 39 ) Bouchardat and Bernard, ( 30 ) 
have proved on the contrary, that the blood of diabetic persons 
preserves its alkalinity, and that the alkalies of the blood do not 
promote the oxidization of sugar to the extent asserted. 

Direct experiment and clinical facts, on the other hand, have 
shown that, in certain derangements of the nervous and circu- 
latory systems and of the constituents of the blood, the produc- 
tion of grape sugar is increased and it passes into the urine ; 
and farther, that the alkaline carbonates diminish the proportion 
of sugar in the urine of diabetic patients. 

We may then employ the alkaline carbonates in the treatment 
of diabetes mellitus, although their action upon glucose in the 
animal economy is not well understood, and probably differs 
both in degree and kind from that asserted by Mialhe. 

August 20th. — Feels very weak, and complains of a pain in 
the region of his liver. Bowels are still irregular, but improving. 
Pulse, ... 72. Temperature of Atmosphere, 83° F. 
Inspiration, 14 " " Hand, .... 97° 

" under Tongue, 100±° 

August 26th. — Improving in strength and spirits. Digestive 
function restored. Slowly gains flesh. Digests large quantities 
of meat with ease. 

$. Cane sugar ixij. during the 24 hours. 

scribes lime water, magnesia, vichey water, bicarbonate of soda, alkaline and 
vapor baths, flannel, friction, exercise, animal diet^ and sometimes sudorifics. 
M. Mialhe relates the case of an Italian professor of music, afflicted with diabetes 
mellitus. Under the alkaline treatment the sugar rapidly diminished and the 
patient recovered. 

(29) Prof. C. G. Lehmann injected a solution of grape sugar, prepared from 
starch, into the veins of 37 dogs and rabbits, and in every instance grape sugar 
appeared in the urine; and the reaction of the urine was acid. The sugar pass- 
ed so rapidly into the urine, that it was frequentlj* detected five minutes after its 
injection, and then when only O'l of a gramme was injected. 

Caustic, alkalies, and their carbonates, associated with grape sugar, were also 
injected into the veins of rabbits. 

Notwithstanding the caustic, alkalies and the carbonates, the urine not only- 
contained grape sugar, but also exhibited an acid reaction. 

Prof. Lehmann also injected dilute solutions of tartaric and citric acids into the 
stomachs of rabbits and dogs, fed on food poor in alkalies. Although the blood 
was thus rendered poor in alkalies, while at the same time vegetable acids were 
introduced, still not a trace of sugar appeared in the urine. — Physiological Chem- 
i.-try, by Prof. C. G. Lehmann. English Ed., voL hi., p. 233. American Ed., 
vol. ii., p. 357. 

These experiments have been repeated by Uhle, with similar results. — Dis. 
Iuaug. Med. Lips., 1852. p. 19. 

(30)Moniteur des Hopitaux, May 14, 1857. 



314 Jones, on Diabetes Mellitus. [May, 

Hoppe's( 3 1 ) Investigations upon the action of cane sugar upon 
the animal economy have established the following facts : 

1. No trace of grape sugar was found in the urine or feces 
during continued feeding with cane sugar. 

2. When sugar and meat were given together, the weight of 
the animal increased much more rapidly than when meat alone 
was given. 

3. When sugar and meat were consumed, urea was excreted 
in smaller quantity than when meat alone was taken. 

4. By exclusive sugar diet, the excretion of urea was de- 
pressed to its lowest amount. 

5. By the presence of much sugar in the blood, the albumin- 
ous substances are preserved from oxidization. 

The albumen thus stored up appears to be decomposed during 
the development of fat. In this manner sugar produces fatten- 
ing, only when, at the same time, albuminous substances are 
liberally supplied. 

6. The temperature of the body was not increased, by the 
addition of sugar to the allowance of meat. 

7. The health of the animals experimented on, was in no way 
injured by feeding on large quantities of cane sugar, in addi- 
tion to a liberal supply of meat. 

September 23rd. Has continued steadily to improve in health 
and strength, and is now able to walk about the hospital grounds 
and assist in nursing the patients. 

The amount of urine voided daily has diminished. 

October 20th. His muscular and nervous forces have increased 
greatly. His face and limbs have filled out. His spirits are ex- 
cellent; and he says that he is now as fleshy as in health. 

He is able to act as assistant nurse, and often sits up all night 
with those patients who require his services. 

The amount of urine excreted daily has greatly diminished, 
and ranges from seventy to ninety fluid ounces. 

The grape sugar has diminished greatly in amount, but has 
not entirely disappeared. 

At this date I resigned the charge of the Savannah Marine 
Hospital and Poor House. 

(31) F. Hoppe, on the Influence of Cane Sugar in Digestion and Nutrition. — 
Virchow's Archiv., vol. x., pp. 144, S. S., 1856. 



1858.] DuGAS. New Principle of Diagnosis. 315 

It is evident, that sufficient time had not elapsed to warrant 
the assertion that this case was cured ; nevertheless, the reme- 
dies used produced decided beneficial effects, and were the 
means, in Providence, of arresting the disease, when the patient 
appeared to be in the last stages of diabetes mellitus, and upon 
the borders of the grave. 

I have endeavored to give a simple statement of the facts ob- 
served in this case, the plan of treatment pursued, and the reasons 
which led me to the adoption of this mode of treatment. 

Although this is but a single case, the treatment of which was 
not even conducted to its termination in complete health, or 
death, still, I am persuaded that, in the present state of Medical 
Science, every successful effort to arrest so formidable a disease 
as Diabetes, even for a few months, will be considered worthy 
of an examination by Practitioners of Medicine. 



AETICLE XIII. 



A Xew Principle of Diagnosis in Dislocations of the Shoulder-joint. 
E y L. A. Dcgas, M. D., Professor of Surgery, in the Medical 
College of Georgia.* 

Having for a number of years inculcated in my lectures the 
principles contained in this paper, I was requested to reduce 
my views to writing, for the benefit of our classes, and according- 
ly published an article on the subject in the March number, for 
1856, of the Sout/iern Medical and Surgical Journal, p. 131. 
The object of this communication is to present the American 
Medical Association with a brief expose of this interesting sub- 
ject, and to accompany my remarks with pictorial illustrations, 
calculated to impress the eye as well as the understanding of the 
reader. 

The principle of diagnosis to which I refer may be enuncia- 
ted in the following language : If the fingers of the injured limb 
can be placed by the patient or by the surgeon upon the sound 
shoulder, while the elbow touches the thorax, there can be no dis- 
location; aud if this cannot be done, there must be a dislocation. 
In other >vords, it is physically impossible to bring the elbow in 

* The above Report was read before the American Medical Association, and 
printed in the loth Volume of the Transactions. 
K.s. — vol. xrv. no. v. 14 



816 



DUGAS. New Principle of Diagnosis. 



[May, 



contact with the sternum or front of the thorax if there be a dis- 
location ; and the inability to do this is proof positive of the ex- 
istence of dislocation, inasmuch as no other injury of the shoul- 
der-joint can induce this inability. 

In order to make these propositions apparent, I beg leave to 
present drawings taken from the skeleton, showing the relative 
position of the bones in the natural state, and in the several dis- 
locations of the shoulder. The evidence thus obtained in sup- 
port of my principle, would be still stronger if the bones were 
invested with their normal coverings and attachments. 

Let us then look at Fig. 1, and we may observe, that while 
the head of the humerus occupies the glenoid cavity, and the fin- 
gers rest upon the other shoulder, the elbow and lower end of 
the humerus lie upon the thorax without difficulty, because of 
the circumstance that the head of the humerus, when in its natu- 
ral position, is removed several inches from the ribs. In con- 
sequence of the rotundity of the thoracic walls it is physically 
impossible that both ends of the humerus should at the same 
time come in contact with the chest. We see, therefore, in Fig. 

Fig. 1. 




1, that in the absence of any dislocation, the upper half of the 
bone does not touch the thorax, and that the lower half does so 
without the least difficulty. 



1853.] Dug AS. New Principle of Diagnosis. 317 



Fig. 2. 




By now referring to Fig. 2, which represents a dislocation into 
the axilla, we find that, the fingers being placed upon the oppo- 
site shoulder, the elbow is forced so far forwards that it cannot 
touch the thorax. In this state of things, the upper end of the 
humerus alone touches the ribs, while the lower end is propor- 
tionately removed from the chest. Any attempt to force the 
elbow against the thorax must be fruitless, unless at the expense 
of a disruption of all the soft parts by which the head of the hu- 
merus is held down ; for, as I have already stated, it is physical- 
ly impossible for both ends of the humerus to touch the thoracic 
walls at the same time. 

We have represented, in Fig. 3, a dislocation forwards or be- 
low the clavicle ; and here again we find the upper end of the 
humerus resting upon the ribs — the elbow being consequently 
removed from the chest. The upper half of the humerus touches 
the thorax, and so long as this is the case, it is physically impos- 
sible for the lower portion of the humerus also to do it. In dislo- 
cations of this kind, it is very difficult to carry the fingers upon 
the opposite shoulder, even though the elbow be allowed to pro- 
ject forward, because of the resistance offered by the strong mus- 
cles which pull back the humerus. I have, however, represen- 
ted the bones of the skeleton in this position, for the purpose of 



318 



DuGAS. New Principle of Diagn 



osis. 



[May, 



showing the effect, in case it could be assumed, in the living 
subject. 

Fig. 3. 




Dislocations of the humerus upon the dorsum of the scapula, 
although very rare, should still be carefully studied. I have, 
therefore, represented this accident in Fig. 4, by which it may 

Fig. 4. 




be seen that the same principles are applicable also to it. Here, 



1858.] Dugas. New Principle of Diagnosis. 319 

as well as in the other instances, it is only the upper end of the 
humerus that touches the thorax, and the elbow projects strong- 
ly forwards. In this dislocation, it might be possible to bring 
the elbow against the side of the trunk, by carrying the hume- 
rus down parallel with the axis of the body ; but any contact 
of the elbow with the chest is impossible, if the fingers be directed 
towards, or placed upon the sound shoulder, for then the form 
of the thorax would offer an insuperable obstacle. 

Having now, I trust, sufficiently demonstrated the truth of 
the proposition that it is physically impossible to bring the elbow 
against the front of the thorax in dislocation of the shoulder, I 
would simply add, that it is equally true, that no other injury 
of the shoulder-joint than a dislocation can induce this physical 
impossibility. It is obvious, that a mere contusion of the soft 
parts may render motion of the joints so painful as to deter the 
patient from the effort necessary to carry the fingers upon the 
other shoulder. But there can be no difficulty on the part of 
the surgeon in placing the limb in this position, and an anaesthe- 
tic might be used, if desirable, so as to render manipulation pain- 
less. The same may be said of fractures of the upper end of the 
humerus, of the acromion, of the coracoid process, and of the 
neck of the scapula. In neither of these accidents can there be 
any physical impediment in the way of bringing the elbow in 
contact with the front of the chest, for in neither of them can 
the upper end of the humerus be so fixed against the ribs as to 
make it impossible for the lower end to touch the chest. Nothing, 
therefore, but a dislocation can prevent the limb from being 
placed in the position indicated. 

If it be justly esteemed a matter of great importance to be in 
possession of correct principles of diagnosis in occult diseases, it 
is certainly not the less so with regard to surgical accidents, es- 
pecially when these demand prompt interference. Our profes- 
sional records unfortunately establish too conclusively the im- 
perfection of our diagnostic resources in injuries of the joints, to 
permit any indifference on the subject. If, therefore, the views 
here presented may facilitate, in the least degree, the detection 
of injuries confessedly more or less obscure, my object will have 
been attained. 



320 Supra-renal Capsules and Bronzed Skin. [May, 

Supra-renal Capsules and Bronzed Skin. By George Harley, 
M. D., F. R. C. S. London. 

[The following condensed analysis of the above paper published 
in the British and Foreign Med. Chir. Review, presents a compre- 
hensive resume of the various opinions and experimental results 
upon the subject. It is by Dr. Austin Flint, Jr., and is transfer- 
red from the Buffalo Journal. — Edts.] 

The Supra-Renal Capsules. By Austin Flint, Jr. — Medical 
practitioners have always occasionally met with a disease affect- 
ing the color of the skin and accompanied by extreme emacia- 
tion, of the pathology of which they were utterly ignorant. We 
ourselves had an opportunity of seeing such a case in the wards 
of Prof. Flint, at the Buffalo Hospital of the Sisters of Charity. 
In this case, as far as our memory serves us, the patient was ex- 
ceedingly emaciated ; had cough and extensive pulmonary disease, 
and was affected with a brown discoloration of the skin, which 
was general, with the exception of spots over the body of dazzling 
whiteness, which were of irregular shape, and varied in size from 
that of a sixpence to a dollar, or in a few places were even lar- 
ger. The patient died a few days after his admission into the 
wards, but no autopsy was made. 

A short time after this, we saw a notice of a monograph by Dr. 
Addison, on " The supra-renal capsules and iheir connection with 
Bronzed Skin." Dr. Addison has made a number of post-mortem 
examinations of patients who where affected with this peculiar 
discoloration of the integument, which he denominated " Bronzed 
Skin" and invariably found associated with it a disease or disor- 
ganization of the supra-renal capsules, by which their function 
was entirely abolished. As Addison was the first to point out 
any connection between bronzed skin and disease of these organs, 
it has been proposed that the disease shall be called "Addison's 
Disease," as albuminuria connected with organic diseases of the 
kidneys was named after its distinguished discoverer, Dr. Bright. 
Physiologists, as is well known, have never been able to deter- 
mine definitely the function of the ductless glands or the blood 
glands, as they are sometimes called ; which are the spleen, thy- 
noid and thymus glands, mesenteric glands and the supra-renal 
capsules. These organs have all the anatomical characteristics 
of ordinary glands, with the exception of ducts ; and, as owing to 
this, their secretion, if they have any, cannot be subjected to 
analysis, their role in the economy has remained almost unknown. 
In none of these, however, has the obscurity been so great as in 
the case of the supra-renal capsules. The brilliant experiments 
of Bernard in regard to the Glucogenic function of the liver, 



1858.] Supra-renal Capsules and Bronzed Shin. 321 

which so surprised and delighted the scientific world, and which 
made such an advance into the pathology of that hitherto unac- 
countable disease, diabetes mellitus ; gave a new impulse to the 
study of the ductless or blood glands; as by these experiments 
Bernard has shown that the liver, in addition to its office as a 
bile secreting organ, formed sugar within its substance, which 
was given up immediately to the mass of blood without the inter- 
vention of an excretory duct : since this was discovered, it has 
been shown that the liver also produces fat de novo, though as 
much is not known about this function as about the production of 
sugar. Thus the liver, in addition to being an ordinary gland, 
possessed of an excretory duct, is in reality a blood gland like the 
spleen, or supra-renal capsules. 

A great proportion of the energy of the investigations into the 
functions of the ductless glands hasbeen directed towards the spleen, 
and it is now supposed, and on pretty good foundation, that the 
spleen and mesenteric glands have an important office in the for- 
mation of blood globules. The physiology of the supra-renal cap- 
sules, however, had still remained buried in its original obscurity. 

Upon the appearance of the excellent monograph by Dr. Addi- 
son, observers in all parts of the world set themselves to work upon 
the physiology of the supra-renal capsules ; the paper of Addison 
having thrown some light on the subject, and seeming indeed to 
establish some connexion between these organs and the formation 
of pigment, or the regulation of its deposition. The Physiologists 
who have made known to the world the results of their experi- 
ments, are Gratiolet, Brown Sequard, Philipeaux, and Dr. Harley, 
of University College, London. The experiments of these gen- 
tlemen, whose names our readers will recognise as belonging to 
men eminent in this department, have led them to somewhat dif- 
ferent results : we had the pleasure of listening to lectures by Dr. 
Brown Sequard on this subject a year ago, when he seemed to 
prove that the supra-renal capsules were essential in the highest 
degree to life, even more so than the kidneys themselves ; as an 
animal survived for two or three days after the extirpation of the 
kidneys, but it lived for a few hours only after the removal of the 
supra-renal capsules. Brown Sequard also showed that animals 
from whom these organs had been removed, were convulsed and 
affected with that peculiar nervous phenomenon which is known 
as " turning," this turning always being in the same direction. 
He also asserts that death supervenes too rapidly to be due to 
inflammation of the peritoneum, and indeed, on examining this 
membrane after death, no evidences of inflammation are observed. 
Brown Sequard performed experiments in the presence of his 
audience, and we had an opportunity of witnessing the phenome- 
na which he described. 

The most elaborate and satisfactory paper on this subject which 



322 Supra-renal Capsules and Bronzed Skin. [May, 

we have yet seen, is from the pen of Dr. Harley, and appeared 
in the last number of the British and Foreign Medico-Chirurgi- 
cal Review. Thk article we have carefully perused, and it was 
this which led us to make the preceding observations. Think- 
ing this subject to be of great importance to us as Physiologists 
and Pathologists, we have been thus extended in our remarks, and 
will give a brief recapitulation of the more important results at 
which Dr. Harley has arrived ; this we deem the more appropri- 
ate, as it is probable that many of our readers do not have an 
opportunity of seeing the above mentioned periodical. 

In anatomical structure, these organs present no very striking 
points of difference from some of the ordinary secreting glands of 
the economy ; they are formed of a medullary and cortical sub- 
stance like the kidneys. There is a peculiarity however in their 
chemical constitution. " In the beginning of the last year, M. 
Vulpian communicated to the Societie de Biologie the discovery 
a very peculiar reaction possessed by the super-renal capsules of 
vertebrated animals. He found that an aqueous solution of iodine 
brought in contact with the medullary substance gave rise to a 
beautiful rose color. And further, that the greater portion of 
oxidizing agents acted like the iodine solution, although in a 
minor degree. Even the oxygen of the air, under the influence 
of light, produced the same effect. I have repeated M. Vulpian's 
experiment on the medullary substance of the supra-renal capsules 
of sheep with success ; but am equally at a loss with the author 
to form an opinion as to the nature of the substance which pos- 
sesses the strange property alluded to. We as yet know so little 
regarding the nature of color and coloring matter, that it would 
be futile to attempt to draw any conclusions with regard to the 
import of the rose colored reaction above spoken of." 

" Not being able to separate the coloring matter, M. Vulpian, 
in concert with M. Cloez, proceeded to extract the " immediate 
principles" of the supra-renal bodies; and these gentlemen have 
recently communicated to the Institute de France as the result of 
their united labors, the discovery of hip-puric and tanrocholic 
acids in the supra-renal capsules of herbiverous animals. But as 
these substances have been abundantly found in different parts of 
the animal body, their discovery in the latter organs, although in- 
teresting, unfortunately throws no light upon the nature of their 
functions." 

Dr. Harley has since seen a communication from Prof. Vir- 
chow, in which he confirms the observation of M. Vulpian with 
regard to the rose colored reaction, and also mentions that he has 
found senecine in the medullary substance. 

The question arises whether the supra-renal capsules are or- 
gans peculiarly essential to foetal existence and developement. 
It was formerly supposed that this was the case, and the argu- 



1858.] Supra-renal Capsules and Bronzed Skin. 323 

ments in favor of this idea, were the great relative size of these 
bodies in the foetus, and their small size in adults. Meckel states 
that at the third month, the supra-renal*capsules and kidneys are 
of equal size, at the sixth month as 2 to 5. at birth as 1 to 8, and 
in adult life as 1 to 28. Later observations, however, by the 
author, Brown Sequard, and others, show a different result in the 
case of some of the mammalia. Dr. Harley has been confined in 
his observations to the cat, having examined thirteen foetal and 
six adult capsules. Without giving the figures and calculations, 
we will give the results at which Dr. Harley has arrived and in 
which he confirms Ecker, Frey, and others: "The weight of 
the supra-renal capsule in the kitten at birth is to that of the kid- 
ney as 1 to 57.3 ; and in the adult as 1 to 54.8. But as so few 
adult capsules and kidneys were employed, it may be perhaps 
better to take the average of the whole six that were examined, 
which would then give us the relative weight of three organs in 
the full grown animal as 1 to 46.49. 

" We shall find by a very simple calculation that the kidney 
was after birth increased 12.35 times in weight, while the supra- 
renal capsule at the same time has increased 14.87 times in weight. 
What conclusion are we to draw from this fact ? We here see 
that the supra-renal capsules increase in size, as age advances, at 
a greater rate than the kidneys. I must here speak with caution 
however. Small statistics are dangerous data to draw conclusions 
from, and perhaps a larger number of observations might furnish 
us with different results." 

Thus our readers will see that Ecker, Frey. and Brown Sequard, 
whose observations are here confirmed by Harley, have develop- 
ed an exceedingly important fact in relation to the probable com- 
parative activity of the function of the supra-renal capsule, what- 
ever it may be, in foetal and adult life: conecting the doctrines 
promulgated by Meckel, that these organs in the mammalia dimin- 
ish after birth, both in relative size and activity of function. 

We now come to experiments, bearing^directly on the function 
of the supra-renal capsules. The first experiment was on an 
adult cat, from which the right capsule was removed. The ani- 
mal survived nine days after the operation, and on post mortem 
examination, no cause of death could be discovered. 

Another experiment was made on a white cat, from which the 
capsules were removed. This died in twenty-four hours, and on 
examination there were found all the indications of peritonitis. 

Another experiment was made on a small white coach dog, 
from which the left capsule was removed. It died on the twelfth 
day, and on examination, signs of peritonitis were discovered. 

An experiment was then made on two Guinea pigs, in one of 
which the abdomen was opened, and the amount of injury 
which the parts would suffer by the removal of the supra-renal 



321 Supra-renal Capsules and Bronzed Skin. [^ay, 

capsules, was inflicted, the wound sewed up, and the capsules al- 
lowed to remain; the fellow, which was of the same age, sex, and 
development, was then deprived of the capsule on the correspond- 
ing side. Both these animals died within twenty-four hours after 
the operation. The same experiment was then repeated on two 
cats. The cat from which the supra-renal capsule (the right,) 
was removed, lived two days; the other died during the third 
night. In the abdomens of both, signs of peritonitis were dis- 
tinctly visible. 

The next experiment was made on a bull terrier dog, by re- 
moving one of the capsules without applying a ligature to the 
vessels, the body being enucleated with the fingers. The dog 
remained in the author's possession for five months, and did not 
suffer from a day's illness. 

The next experiment was of exceeding interest : it was on a 
large torn cat, in which, on opening the abdomen, the right cap- 
sule was rough and hard as a stone : it was enucleated with the 
greatest facility. The same operation was repeated on the other 
side with a similar result. On making a section of the capsules, 
it was found that a considerable portion of the medullary, as well 
as of the cortical substance, had become replaced by a calcareous 
deposit, consisting chiefly of carbonate of lime. The remaining 
portion of the gland contained so much fibrous tissue, that the 
normal structure might be said to have entirely disappeared. iVs 
the operation on this animal had been performed with the utmost 
facility, and there had been no haemorrhage, or any apparent in- 
jury done to the surrounding parts, except the tearing through the 
vessels and nerves, the author felt sanguine of success. His as- 
tonishment was great therefore when, arriving at the college next 
morning, he found the cat dead. The post mortem examination 
revealed nothing, though the blood was searched for signs of 
phlebitis, examined for crystals, and for the flakes of pigment des- 
cribed by Brown Sequard. As it has been found by Ludwig and 
HafFer, that section of the splanchnic nerves will kill animals in 
one or two days, and according to Brown Sequard, mere 
pricking or cutting of the semi-lunar ganglion proves fatal to rab- 
bits in thirty hours, while division of the sympathetic in the 
neighborhood of the kidneys causes death in twenty-three hours : 
in absence of other proof of death, it is probable that it resulted 
from injury done, in tearing out the capsules, to the ganglionic 
system of nerves. 

The extirpation of the right is more fatal than the removal of 
the left capsule, as it proved by experiments which the author has 
cited, but which it is unnecessary for us to state. M. Gratiolet 
thought that this fact was to be explained by the proximity of the 
liver, and the occurrence of hepatitis; at first Dr. Harley was 
of this opinion, but he now very justly concludes that it is due to 



1858.] Supra-renal Capsules and Bronzed Skin, 325 

another cause. The right semi-lunar ganglion, which is much 
larger than the left, lies (in the dog and cat) directly beneath the 
supra-renal capsule; while the smaller left semi-lunar ganglion is 
placed on the left cms of the diaphragm, and internal to the supra- 
renal body. Thus it will be immediately seen that a removal of 
the right capsule will do more mischief to this ganglion, and this 
injury has been shown by Ludwig, H after and Brown Sequard 
to be sufficient to produce death in a short time. 

As it is generally the case in the removal of double organs, that 
if one be left it becomes hypertrophied from being compelled to 
perform a double function. Dr. Harley was anxious to observe 
if this was the case as respects the supra-renal capsules. He 
accordingly removed the right capsule from a cat, which had 
made an excellent recovery from the operation of removing the 
left about a month before. Nothing unusual, however, was 
observed : on the morning of the third day it died, and on open- 
ing the abdomen, two of the lumbar lymphatic glands were ob- 
served very much enlarged, and presenting a peculiarly beautiful, 
semi-transparent, lobular appearance. 

Dr. Harley performed another experiment on a piebald rat, 
with reference to the same point. The right supra-renal cap- 
sule was removed, and the animal made a rapid recovery, being 
in excellent condition at the end of six weeks. The left cap- 
sule was then removed, and compared with others taken from 
animals of the same species and age, in order to ascertain if it 
had become hypertrophied. But in this, as in the case of the cat, 
there was no very marked difference in either its size or appear- 
ance. From the effects of the latter operation the animal speed- 
ily recovered, and ultimately became very fat and healthy 
looking. 

An experiment was made on a white rat, in order to observe 
if any change would take place in the color of the hair and skin. 
Both capsules were removed at an interval of nine days. The 
animal lived sixteen days after the last operation, and during that 
time the color of the hair and skin was carefully watched, with- 
out discovering any alteration, excepting that the neck became 
denuded of hair, was covered with a luxuriant crop of young hair, 
about an eighth of an inch long. 

The foregoing experiments, which we have presented in as con- 
densed a form as was consistent, cannot fail to strike every one 
as extremely interesting, and leading to some very important 
conclusions. Brown Sequard has maintained that it is impossi- 
ble for an animal to live for more than forty-eight hours at the 
farthest, after it has been deprived of its supra-renal capsules. 
The experiment of Dr. Harley fully controvert this statement, 
and in addition, M. Philipeaux, of Paris, has removed the spleen, 
supra-renal capsules, and the thyroid body from the same animal, 



326 Apoplexy and Hemiplegia. pJay, 

which afterwards recovered.- Dr. Harley brought with him from 
Paris a young rat, the offspring of a mother which had been de- 
prived of spleen and supra-renal capsules. Brown Sequard is also 
probably in the wrong in supposing that the convulsions and turn- 
ing which followed his experiments, were due to the removal of 
the supra-renal capsules ; as Dr. Harley has not observed it in 
his experiments, and is confirmed by a private letter from Profes- 
sor Virchow, who has also failed to notice this phenomenon. 

We had the pleasure, from the politeness of Dr. Brown Sequard, 
of examining certain microscopic crystals, which he invariably 
found in the blood of animals from which he had removed the 
supra-renal capsules. These crystals w T ere unlike the ordinary 
blood crystals, being pale and needle shaped. Dr. Harley makes 
no allusion to this occurrence. 

Finally we present the conclusions drawn by Dr. Harley from 
the results of his experiments. 

1st. The supra-renal capsules are not solely fetal organs. 

2d. The supra-renal capsules are not absolutely essential to life. 

3d. The removal of the right is generally more fatal than remo- 
val of the left capsule. 

4th. That convulsions do not necessarily folloiu the removal of 
the capsule. 

5th. That the absence of this function (in rats), is attended 
neither by great emaciation nor debility. 

6th. That when death follows upon the extirpation of the supra- 
renal bodies, it is in most cases in consequence of the injury done to 
the neighboring tissues ; perhaps most frequently the mutilation of 
the ganglionic system of nerves. 

7th. Absence of the function of the supra-renal bodies, is not 
proved to have any special effect in arresting the transformation of 
hcematin, or in increasing the formation of blood crystals. 

8th. The suppression of the supra-renal capsular function is 
not attended by any increased depjosit of pigment in the shin in its 
appendages (in rats). 

9th. The problem of the connection of b?*onzed skin and supra- 
renal capsular disease is more likely to be solved in the dead house 
than in the physiological laboratory. 



To lohat Degree are the Intellectual Faculties affected in cases of 
Apoplexy and Hemiplegia f By Benjamin W. M'Ceeedy, 
M. D., Physician to Bellevue Hospital. 

This inquiry, irrespective of its medico-legal relations, is of 
interest and importance to the medical practitioner. Dr. 
M'Creedy brings to bear upon it the results of an analysis of 



1858.] Apoplexy and Hemiplegia. 327 

cases collected from different authors, as well as instances falling 
under his own observation, and communicated to him by medi- 
cal friends. From an examination of " a collection of cases of 
apoplexy," by Mr. Copeman, of London, published in 1845, he 
arrived at the following conclusions : " In all, out of a record of 
two hundred and fifty cases, fifty cases have been taken in which 
the patient had recovered from the first effects produced W the 
apoplectic stroke. They are all the cases contained in the book 
in which such recovery had taken place, and in which the cases 
were clearly of an apoplectic character. Yet in no one of the 
cases is there the slightest indication that the patient was left 
with a mind, I will not say reduced to a state of imbecility, but 
impaired in any marked degree. They all as far as the mind is 
concerned, with the exceptions to be mentioned, recovered ; re- 
covered perfectly ; were restored to their usual state ; returned 
to their previous occupations. In two instances the faculty of 
speech was either deranged or lost, and in those instances their 
physicians assert that the faculty of language, not reason, was 
deranged. In the third^rn stance the patient is stated to have 
recovered with an impaired memory, and with some confusion 
of thought ; but a merchant, seventy-three years of age, who 
after partial recovery from a severe apoplectic seizure, is enabled 
to labor for his support by writing for the weekly papers, may 
be esteemed to have still possessed a fair share of intellect and 
energy. The second attack left him yet more prostrate, very 
much weakened in body, and unable to do anything for the 
support of his family. From the third attack he never recover- 
ed ; still there is nothing like imbecility : he lies for months in 
a feverish condition, alternating between coma and delirium, and 
even a few days before his death he partially recovered and 
talked in a rational manner with his wife." 

The foregoing conclusions are corroborated by the results of 
an examination of a series of cases contained in Andral's Clin- 
ique Medicale, and in the Anatomie Pathologique of Cruveilhier. 
These cases, like the preceding, are quoted in brief detail by the 
writer. In expressing the results of this examination, the writer 
says: "Here then, are sixteen cases in which the condition of 
the intellect before the attack was obscured, in which the nature 
of the disease was verified by post-mortem examination — being 
all that are contained in the Clinique Medicale of Andral, and the 
Anatomie Pathologique o£ Cruveilheir, and reported by men whom 
every one will allow were competent, careful, and conscientious 
observers — in which the hemorrhage was situated in almost 
every part of the brain, presenting every degree of severity com- 
patible with the continuance of life, many of them liviDg for 
years after the occurrence of the apoplectic seizure, and yet in 
only two of these was there any decided improvement of the 
mind noticed." 



828 Apoplexy and Hemiplegia. [May, 

The writer adds : " Perfectly in accordance with this have 
been the results of my own observations. At Bellevue, the 
great pauper hospital of the city, there are always a number of 
hemiplegiacs ; but since my attention has been directed to the 
subject, I have seen no case in which hemiplegia has been the 
consequence of a well-marked apoplectic seizure, in which I 
have found the intellect seriously impaired. In some of these 
cases the first impression of the observer is wholly unfavorable 
to - the intelligence of the patients; the distorted countenance, 
the impaired speech, and the motionless tears or laughter, give 
them an appearance of utter imbecility ; yet a patient examina- 
tion will commonly discover an amount of intelligence en- 
tirely unexpected." * * * - " From the facts given above, 
no other conclusions can be drawn than that any impairment of 
mind, as a direct consequence of apoplexy, after the patient has 
recovered from its primary effects, must be an exceptional occur- 
rence. That the apoplectic seizure may hasten the approach of 
senile atrophy of the brain is, as before stated, probable ; when 
atrophy has already commenced, an apoplectic attack may un- 
doubtedly quicken its progress, and, in such a case, the friends 
of the patient would naturally attribute the rapid decay of the 
mind wholly to the apoplectic seizure. This, I think, I have 
myself seen ; and as apoplexy becomes more common as life 
advances, such cases may not be unfrequent. The confusion of 
mind, the difficulty in pursuing a train of thought, of which 
apoplectics are apt to complain, is to a great extent the mere 
result of diminished nervous energy. They comprehend well, 
and judge correctly, but, before their general health is confirm- 
ed, they can no more think continuously than they can take a 
long walk, or perform any other act demanding a considerable 
expenditure of nervous force. It is not the brain specially that 
is affected — it is the system at large. Of all the faculties, memory, 
either special or general, is most apt to be impaired, and this 
impairment patients are always ready to admit and complain of. 
As the patient recovers, the memory commonly improves ; and 
if no new attack supervene, this improvement is progressive for 
years." * * * "Whence, then, arises the number of imbeciles 
who are to be found in every almshouse? Partly, doubtless, 
from the cases already mentioned, in which senile atrophy is 
prematurely caused, or its progress hastened by the occurrence 
of apoplexy. And let us recollect the state of isolation and 
neglect from which such persons frequently, often necessarily, 
suffer, is in itself a main cause of a weakened intellect: the mind 
rusts out for want of exercise." 

The writer details a series of cases in which, while the hear- 
ing remained unaffected, the patient's consciousness entire and 
no delirium, the faculty of speech was either lost or perverted. 



1858.] Apoplexy and Hemiplegia. 329 

He remarks on these cases as follows: — " Here, it will be seen, 
are eleven well-marked cases of hemiplegia, three of them com- 
plicated with epileptic convulsions, and all of them with loss or 
perversion of the faculty of speech. Besides the cases here re- 
corded, three more have come to ray knowledge the subjects of 
which, I believe, are still living. This shows conclusively the 
loss of speech, as an accompaiment of hemiplegia, to be no very 
rare occurrence. Of the whole fourteen cases, two have perfect- 
ly recovered the use of speech; two have recovered it to a par- 
tial and limited extent ; the others still, I believe, remain speech- 
less. From the cases recorded in the journals to which I have 
access, I believe that recovery from perversion of the faculty of 
speech is more common and perfect than when the power of ar- 
ticulation is either wholly lost or confined to a few monosyllables. 
Direct medication, except in so far as it improves the general 
health of the patient, seems to have no effect on the lost faculty ; 
more is to be hoped for from careful, long continued, and well- 
directed exercise of the local organs by the patient himself." 

The foregoing conclusions are certainly at variance with the 
views inculcated by medical writers and commonly held by prac- 
titioners. The general belief is, that after an apoplectic seizure, 
as a rule, the mind is more or less impaired, and in severe cases 
the patient is apt to fall into a condition of partial or complete 
imbecility. Epilepsy is also supposed to tend intrinsically to 
induce deterioration of the mental faculties in proportion to the 
frequency and severity of the paroxysms. Assuming that the 
writer's conclusions are correct, it is in a great measure owing to 
the pervailing error on the subject that the faculties of the mind 
are in a certain proportion of instances, permanently damaged ; 
and it becomes a very important point in practice to enjoin, un- 
der judicious restrictions, that degree of exercise of the mental 
faculties which shall secure their healthful if not vigorous activi- 
ty. This practical point is especially applicable to the manage- 
ment in cases of epilepsy. The reviewer has long entertained 
the opinion that, in this affection, the mental deterioration which 
is frequently observed is not due so much to an intrinsic tenden- 
cy of the malady as to the isolation and inactivity incident to it. 
With reference to epilepsy, the author of the highly interesting 
paper which we have reviewed, states that he has ''repeatedly 
seen and prescribed for a person who has had epilepsy for thirty- 
three years, occurring several times in every month, and some- 
times eight and ten times a day ; in whom, though there is obvi- 
ous enlargement of one side of the head, and much headache, 
and the tongue bears the marks of countless lacerations, yet it 
is impossible to discover in this person the least change in her 
mental condition." He adds, that "both the medical profys- 
eion and the judicial bench of the city can each furnish at least 



330 On the Medicinal Hypophosphites. [May, 

one illustration of the distinction and usefulness to which 
persons who have been, or still are, subject to epilepsy, may 
attain." — [New York Jour, of Medicine. 



Remarks on the Medicinal Ilypophosphites* By William Proc- 
tor, Jr. 

[In our last number, we presented to our readers, a striking 
article from Dr. Churchill, on the use of the Hypophosphites, in 
the treatment of Tuberculosis. We here transfer to our pages a 
paper in which these several salts and their mode of preparation 
are described. — Edts.] 

The recent researches of Dr. Churchill into the therapeutic 
character and value of the hypophosphites in tuberculosis, some 
account of which will be found at page 143 of this number, have 
attracted much attention from physicians, and many inquiries 
have been made after these salts ; and it is believed that a notice 
of the processes for preparing them, and some formulas for their 
prescription, will be acceptable to the readers of the Journal, es- 
pecially, as from their hitherto unimportant position among phar- 
maceutical chemicals, no mention is made of them in works most 
accessible. The salts which have been used are those of lime, 
soda, potassa and ammonia. In the sequel a notice is given of 
these, of the hypophosphite of sesquioxide of iron, and of hypo- 
phosphorus acid. 

The hypophosphites, according to Gmelin, are mostly crystal- 
lizable. They cannot exist without a certain proportion of water, 
which is equally true of the acid itself, which in its most concen- 
trated form contains three equivalents of water, one of which is 
replacable by bases. When heated till decomposed, these salts 
emit phosphuretted hydrogen. They are permanent in the air as 
regards oxidation ; but when heated in solution, especially if free 
alkali is present, they are decomposed into phosphates and hydro- 
gen gas. They are nearly all soluble in water, and several of 
them in alcohol, and readily reduce the soluble salts of silver and 

S old 

Hypophosphite of Lime is the most important of these salts, as it 

not only, by oxidation in the economy, will afford phosphate of 
lime in a nascent state, if needed, but its reaction with the carbo- 
nates of the alkalies give a ready means of obtaining the alkaline 
hypophosphites. When phosphorus is boiled with milk of lime it 

* The Hypophosphites are manufactured in quantity by Hennell Stevens, of 
Philadelphia, who is successfully directing his attention to the supply of new 
chemicals for medicinal use, and fine chemicals in general. 



1858.] On the Medicinal Uypophosphites. 331 

gradually disappears, with evolution of spontaneously inflamma- 
ble phosphuretted hydrogen, which explodes as it reaches the at- 
mosphere with the formation of water and phosphoric acid. When 
the strong odor of phosphuretted hydrogen ceases to be given off, 
the liquid contains, besides the excess of lime, nearly half of the 
phosphorus as phosphate of lime, and the remainder, deducting 
the considerable portion which has escaped into the air as phos- 
phuretted hydrogen, as hypophosphite of lime. According to 
Wurtz, more than one equivalent of water is decomposed, and 
the phosphuretted hydrogen is accompanied by free hydrogen. 
If this be true, the source of the super oxidation of so much of the 
phosphorus is traceable to the resulting oxygen; but Rose is of the 
opinion that this oxygen is derived from the atmospheric air in 
contact with the boiling liquid. When the process is conducted 
in a flask, it requires a constant ebullition of the liquid to prevent 
the explosion consequent upon the entrance of the atmospheric 
air. To avoid this result, it has been found safer to employ a 
deep, open vessel. The constant evolution of gas and vapor, 
which keeps a froth on the surface, excludes the atmosphere in a 
great degree, so that the yield is not much diminished, whilst the 
safety and easiness of the process is greatly increased. The pro- 
cess should be conducted under a hood with a strong draught, or 
in the open air, to avo id the disagreeable fumes which are evolv- 
ed. 

Take of Lime recently burned 4 lbs. av. 

Phosphorus 1 lb. " 

Water, 5 gals. 

Slake the lime with a gallon of water, put the remainder in a 
deep boiler, and as soon as it boils add the slaked lime, and mix to 
a uniform milk. The phosphorus is now added, and the boiling 
is kept up constantly, adding hot water from time to time, so as 
to preserve the measure as nearly as may be, until it is all oxidi- 
zed and combined, and the strong odor of the gas has disappeared. 
The mixture froths much, and but little of the phosphorus reaches 
the surface. Then filter the solution through close muslin, wash 
out that portion retained by the calcareous residue with water, 
and evaporate the filtrate till reduced to six pints. The concen- 
trated liquor should now be re-filtered to remove a portion of car- 
bonate of lime which has resulted from the action of the air on 
the lime in solution, and again evaporated till a pellicle forms, 
when it may be crystalized by standing in the drying room, or 
the heat may be continued with stirring till the salt granulates, 
when it should be introduced into bottles. 

Hypophosphite of lime is a white salt with a pearly margarin- 
like lustre, and crystalizes in flattened prisms. Its composition, 
according to Wurtz, is CaO ,-|-2HO,PO, the water being essen- 
tial to the salt. It is soluble in six parts of cold water, and in not 
14* 



832 On the Medicinal Hypophosphites. [May, 

much less of boiling water ; it is soluble slightly in diluted alco- 
hol, but insoluble in alcohol sp. gr. .835. 

Ilypophosphate of Soda is prepared by double decomposition 
between hypophosphite of lime and crystalized carbonate of soda. 

Take of Hypophosphite of lime 6 oz. 

Crystalized carbonate of soda - - - - 10 " 
Water, a sufficient quantity. 

Dissolve the hypophosphite in four pints of water, and the car- 
bonate in a pint and a half, mix the solutious, pour the mixture 
on a filter, and lixiviate the precipitate of carbonate of lime, after 
draining, with water, till the filtrate measures six pints. Evapo- 
rate this liquid carefully till a pellicle forms, and then stir con- 
stantly, continuing the heat till it granulates. In this state the 
salt is pure enough for medical use; but if desired in crystals, 
treat the granulated salt with alcohol sp. gr. .835, evaporate the 
solution till syrupy, and set it by in a warm place to crystalize. 

Hypophosphite of soda crystalizes in rectangular tables with 
a pearly lustre, is quite soluble in water and in ordinary alcohol, 
and deliquesces when exposed to the air. Its composition is NO 
-|-2HO,PO. 

Hypophosphate of Potassa is prepared by the same process as 
that given above for the soda salt, substituting 5| ounces of gran- 
ulated carbonate of potassa, in place of 10 ounces of crystalized 
carbonate of soda, and using half a pint instead of a pint and a 
half of water to dissolve it. 

Hypophosphite of potassa is a white, opaque, deliquescent salt,- 
very soluble in water and alcohol. Its greater tendency to absorb 
moisture renders it less eligible for prescription than the soda salt. 
Its composition is KO-|-2HO,PO. 

Hypophosphate of Ammonia is prepared from hypophosphite of 
lime and sulphate or carbonate of ammonia. 

Take of Hypophosphite of lime - 6 oz. 

Sesqui-carbonate of ammonia (translucent) 7.23 oz. 
Water, a sufficient quantity. 

Dissolve the lime salt in four pints of water, and the ammonia 
salt in two pints of water, mix the solutions, drain the resulting 
carbonate of lime, and wash out the retained solution with water. 
The filtrate should then be evaporated carefully to dryness, then 
dissolved in alcohol, filered, evaporated and crystalized. 

This salt is deliquescent in the air, very soluble in alcohol and 
water, and when carefully heated evolves ammonia, and leaves 
hyd rated hypophosphorus acid. The composition of this salt is 
NH 3 -|-2HO,PO. 

Hypophosphite of Sesquioxide of Iron. — This salt may be obtain- 
ed in the form of a white gelatinous hydrate, by precipitating a 
solution of hypophosphite of soda or ammonia with one of sesqui- 
sulphate of iron. The precipitate should be well washed with 



1858.] On the Medicinal Hypophosphites. 333 

water and dried at a moderate temperature. It is necessary to 
avoid using a hypophosphite containing any alkaline carbonate 
or the precipitate will be contaminated with free sesquioxide. 
Thus prepared, this salt is a white, amorphous, tasteless powder, 
like the pyrophosphate, soluble in hydrochloric acid, and in free 
hypophosphorus acid. 

Hypophosphorus Acid, — So far as we are aware, this acid has 
not been employed, in a free state, by Dr. Churchill, but it is high- 
ly probable that it may come into use, should the favorable results 
claimed for its salts be substantiated by new observations. Any 
claims which phosphoric acid may possess as an agent to supply 
the waste of phosphorus and phosphates in the human economy, 
will be more than equalled by this acid. Hypophosphate of bary- 
ta is the salt which is most eligible for the preparation of this acid, 
but it is more convenient to prepare it from the lime salts 
viz: — 

Take of Hypophophite of lime - - - - 480 grains. 
Crystal ized Oxalic acid - - - - 350 grains. 

Distilled water 9 fluid oz. 

Dissolve the hypophosphite of lime in six ounces of the water and 
the acid in the remainder, with the aid of heat, mix the solutions, 
pour the mixture on a white paper filter, and when the liquid has 
passed add distilled water carefully, till it measures ten fluid 
ounces, and evaporate this to 8^ fluid ounces 

The solution thus prepared contains about ten per cent, of terhy- 
drated hypophosphorus acid (HO-|-2HO,PO) a teaspoonful 
representing 6 grains of the acid, which contains 2| grains of 
phosphorus. The dose of this acid solution will probably vary 
from ten minims to a teaspoonful. 

It is proposed to give several forms in which the hypophosphites 
may be conveniently administered, and a few hints to the physi- 
cian in reference to prescribing them. 

The soluble salts of mercury and silver are reduced by contact 
with the hypophosphites. All soluble sulphates and carbo- 
nates are incompatible with the lime salt, and should not be asso- 
ciated with it in prescriptions, if phosphate of lime is indicated in 
the case. The iron salt when dissolved by excess of acid is col- 
ored black by gallotannic acid and drugs containing it, but is not 
blackened by the tannin of cinchona, catechu and krameria; 
hence any preparation containing it may be associated with Pe- 
ruvian bark. The hypophosphites of soda, potassa and ammonia, 
are more or less deliquescent, and when prescribed in powder it 
should be with proper precautions to avoid moisture, as by asso- 
ciation with a considerable excess of sugar of milk. The lime 
salt may be mixed with either this sugar or ordinary sugar. None 
of these salts are soluble in cod-liver oil ; and if given with it, they 
should be dissolved in syrup, and mixed by agitation. Where 



334 On the Medicinal Eypophosphites. [May, 

lactin and glycerin are indicated in the treatment of phthisis or 
dyspepsia, any of these salts may be very elegantly associated in 
the form of syrup. 

Syrup of Hypophosphite of Lime. 

Take of Hypophosphite of lime, an ounce. 

Water, nine and a half fluid ounces. 
White sugar, twelve ounces. 
Fluid extract of vanilla, half a fluid ounce. 
Dissolve the salts in the water, filter, add the sugar, dissolve by 
aid of heat and add the vanilla. The dose is from a tea-spoonful 
(3 J grs.) to a table-spoonful (14.,) according to the circumstances 
of the case, three times a day. 

Compound Syrup of Hypophosphite. — The following formula 
has been made in view of the double purpose to which these salts 
are directed by Dr. Churchill, viz : the increase of nerve force, and 
the elevation of the tone of the several functions concerned in 
alimentation and nutrition ; and will afford an agreeable means 
of testing practically their merit. The iron salt is presented in 
a form well adapted for entering the circulation, whilst the acid, 
besides exerting its solvent power, adds to the agreeable taste of 
the preparation. 

Take of Hypophosphite of lime, 256 grains. 

Hypophosphite of soda, 192 " 

Hypophospite of potassa, 128 " 

Hypophosphite of iron* (recently precipitated) 96 " 
Hypophosphorus acid solution, q. s. or 240 " 

White sugar, 12 ounces. 

Extract of vanilla, \ ounce. 

Water, a sufficient quantity. 
Dissolve the salts of lime, soda and potassa in six ounces of 
water; put the iron salt in a mortar, and gradually add solution 
of hyphosphorus acid till it is dissolved ; to this add the solution 
of the other salts, after it has been rendered slightly acidulous 
with the same acid, and then water, till the whole measures 9 fluid 
ounces. Dissolve in this the sugar, with heat, and flavor with 
the vanilla. Without flavoring, this syrup is not unpleasant, being 
slightly saline, and not at all furruginous. Any other flavoring 
may be used, as orange peel, orange flower or ginger. It is also 
suggested to physicians that glycerine may be used, wholly or 
partially, in sugar when indicated, six ounces and a half of gly- 
cerine being substituted for twelve ounces of sugar. The object 
of acidulating the saline solution is to decompose any alkaline 

*/This quantity 96 grains, of hypophosphite of iron is obtained when 128 grains 
of hypophosphite of soda dissolved in 2 ounces of water is decomposed with a 
slight excess of solution of persulphate of iron, and the white precipitate will 
wash on a filter with water. 



1858.] Diphtherite or Malignant Sore Throat. 335 

carbonates which may be present and which have been noticed 
by the writer in some of the commercial soda salt. The dose of 
this preparation is a teaspoonful three or four times a dav. A 
teaspoonful contains 2 grains of the lime salt, 1| of the soda salt, 
1 of the potassa salt, and £ of a grain of the iron salt, besides a 
little hvpophosphorus acid. — [American Jour, of Pharmacy. 



Reports of Cases of Diphtherite, or Malignant Sore-throat. By 
Benjamin Godfrey, M. D., M.RC.S.L. 

Case 1. J. B , a little boy, aged two years. He had been 

healthy and strong through life, with the exception of the tri- 
vial ailments incident to childhood. Five months ago he 
suffered from discharge of pus from the ear, with occasional 
epistaxis. These ailments soon passed away, and he continued 
pretty well until the present attack. 

Oct. 17th. — The child complained of cold in the head; dis- 
charge of yellow mucoid matter from the nose, with occasional 
haemorrhage, dyspnoea, and dysphagia; great drowsiness and 
extreme languor. The tongue was slightly coated, but not in- 
jected; the skin was moist and comfortable ; the pulse quick 
and feeble, 120 ; pupils dilated. On examino.tion of the throat, 
a small, whitish spot was observed on the mucous membrane of 
the right tonsil, about the size of a pea ; bowels constipated. 
Ordered the sixteenth of a grain of extract of belladona, with 
one grain of carbonate of ammonia, every three hours; a rhu- 
barb and jalap powder at bedtime. 

18th. — The patient is much weaker ; dyspnoea greater, but 
dysphagia less. The spot has become of an ashy hue, extending 
over the right tonsil, and slowly creeping ov» ; r the uvula. Pulse 
130. Kepeat the mixture. 

19th and 20th.— The discharge from the i ? Dse and mouth has 
-increased — very acrid, and of a highly offensive odor; the 
throat externally is much swollen ; the parotid and sub- maxil- 
lary glands are much enlarged ; both tonsils are coated with the 
ulcerative process; pulse 130; tongue coated, white; bowels 
nicely relieved, but great exhaustion and prostration is apparent. 
Ordered carbonate of ammonia and tartrate of iron every three 
hours; port- wine and beef- tea in abundance. 

21st. — Still getting weaker; almost pulseless; extremities 
cold; face palid and anaemic; throat very much swollen exter- 
nally. Ordered warm fomentations; milk, wine, and beef-tea, 
and ten minims of the tincture of sesquichloride of iron every 
three hours. 

22nd. — Less swelling of the throat externally. The black 
gangrenous mass is sloughing away, and a line of demarcation 



336 Diphtherite or Malignant Sore Throat. [May, 

is visible, of healthy granulations springing up to throw off the 
dead foetid mass, and to restore health to the diseased part. 
Dyspnoea less ; dysphagia now but slight. Eepeat the medicine 
and nourishment. 

23rd and 24th. — Very much better. Several pieces of highly 
offensive dead material have passed away. Pulse stronger; 
tongue nearly clean; bowels relieved; pupils less dilated, but 
still drowsy and very weak. 

Day by day the little sufferer improved, and gathered strength 
each day. The only drawback to his recovery was an occasion- 
al attack of epistaxis, which blanched the restored color of the 
cheeks and enfeebled the returning powers. Iron and quinine 
with strong beef-tea and wine, were freely given, but exhaustion 
soon set in, and he died on the 3rd of November, a fortnight 
after the attack, anaemiated and exhausted. 

Case 2. B. B , residing in the same house. He was a 

strong, well-built boy, of excitable temperament, and affection- 
ate disposition. He was taken ill on the 22nd of October. He 
complained of great languor, chilliness, stiffness of the neck, dys- 
phagia, and headache. The tongue was white, but the papillae 
were not more- prominent than they are in irritation of the 
stomach. The throat was much swollen externally, and on the 
tonsil a small ashy spot was seen. No heat of skin ; no dryness, 
but the palms of the hands were moist aud comfortably warm; 
pul ; 3 quick and weak, 130. Ordered the belladonna and ammo- 
nia fixture ev^ry three hours. 

Oct. 23rd. — Bowels freely moved; throat much worse; spot 
very much extended, and the breath extremely foetid ; discharge 
from the nose great ; pupils much dilated ; urine free and nor- 
mal. Ordered to gargle well with warm water, alternating with 
the chloride-of-zinc gargle. Wine and beef- tea to be freely taken, 
and ten drops of the tincture of muriate of iron every three hours. 

24th. — Throat more swollen ; dysphagia greater, and dpspncea 
also increased. Applied nitrate of silver solution, ten grains to 
the ounce, to the throat with a sponge probang. Small pieces 
of black disintegrated mucous membrane came away. Com- 
plains of the wine and beef-tea burning his throat, and causing 
his ears to tingle. 

25th. — The throat is one black gangrenous mass, the odour 
of which is very disagreeable. His powers are fast failing. 
Takes half a pint of port wine a day, with beef-tea, &c. Milk 
also in abundance. 

26th. — Fast sinking. Throat exceedingly swollen ; dyspnoea 
greater than dysphagia; pupils much dilated; extreme drowsi- 
ness, yet perfectly sensible when aroused. He continued failing 
till the 27th, when he expired. 



1858.] Diphtherite or Malignant Sore Throat 337 

Case 3. J. B. , aged seven years, brother of the patient 

before mentioned. lie was attacked with the same disease, with 
precisely the same order of symptoms. He was treated with 
chlorate of potash and cascarilla the former part of the illness, 
and nitro-muriaticacid and gentian the latter part; but in seven 
days from the time he was attacked he also died. 

Case 4. In the same house was a young lady who had 
watched over the before-mentioned children, and on the 28th 
she was also taken ill. The first symptoms were, — Shivering, 
and intense prostration, so powerless that she could not stand; 
tingling of the throat, back of the nares, and in the ears; the 
throat became dry, and deglutition became difficult. On exam- 
ining the throat, there was the plague-striken spot on the left 
tonsil. Ordered four ounces of port wine and strong beef-tea, 
with the nitro-muriatic acid and cascarilla mixture. 

Oct. 29th. — The spot is much increased, extending over the 
uvula. Powers en febled ; pulse 120, very feeble; tongue white 
eand furred; skin cool and moist; bowels regular; urine scanty, 
but natural. She can scarcely breathe through her nose. The 
discharge is increased from the mouth and nose, and the breath 
is become foetid. Ordered the chloride-of-zinc gargle, and 
thirty drops of the tincture of the sesquichloride of iron in infu- 
sion of Columbia root. Strong hydrochloric acid was applied 
with a glass rod to the ulcerated surface. Several large pieces 
sloughed away. 

30th. — Pulse very feeble, and bodily power failing. The 
whole of the soft palate and back of the throat is covered with 
the sloughing mass. The ears and Eustachian tubes are very 
tender and painful. Deglutition is performed with great effort 
and pain. The nares are extremely painful, and the discharge 
acrid and disagreeable. Applied again the muriatic acid. Or- 
dered half a pint of port wine a day, with eggs and beef-tea, and 
to continue the medicine. 

31st. — Still getting weaker. Pulse 130, irritable; skin cold 
and clammy; the wine passes down her threat like liquid fire, 
giving great pain. Ordered wine and beef-tea ad libitum ; the 
iron to be increased in quantity, three drachms of the tincture 
to be taken every day. 

Nov. 1st. — Better; throat less swollen, and dysphagia less; 
bowels well moved; dyspnoea less. At every gargle, pieces of 
dead material came away. Steaming her nose and throat over 
hot water has relieved her much. Skin beautifully warm and 
moist. 

2nd and 3rd. — The throat is granulating quickly; several 
large pieces have been thrown off; fcetor less, and appetite im- 
proving ; pulse 120, fuller and more regular. 



338 Diphtherite or Malignant Sore Throat. [May, 

From this time she began gradually to improve; each day 
pieces of morbid material were brought away. The throat healed 
up in the course of a week or two perfectly, and day by day her 
powers improved, and she left my care on November 15th, quite 
recovered. 

Remarks — The disease appears to me to be confined to the 
mucous membrane, neither touching the muscular nor glandu- 
lar structure. The glandular enlargement is due to sympathetic 
irritation, the same as we see often in other parts of the body ; 
thus a wound in a leg producing an enlarged gland in the groin. 
The question has been asked — " Is it scarlet fever without the 
rash!" This, I think, is answered — 1st, by absence of all fever ; 
2ndly, absence of all rash ; 3rdly, papilae of the tongue not en- 
larged; and 4thly, no desquamation of the cuticle after the 
disease passes off. Yet, on the other hand, scarlet fever existed 
in the adjoining house. It differs also materially from cynanche 
tonsillaris. In that disease the abscess forms within the tonsil, 
and bursts its way out. But in diphtherite, the morbid change 
commences on the surface of the mucous membrane, and is con- 
fined solely to that covering. The extreme and rapid depression 
is only equalled by the depression of malignant scarlet fever, or 
the collapse of Asiatic cholera. Each patient that died appeared 
to sink from exhaustion and partial asphyxia. 

Treatment. — The main point to keep in view is to support the 
patient's powers, and check as far as possible the inroad of the 
disease. The former by stimulants and tonics ; the latter by 
the application of the strong mineral acids. The question may 
arise, might not tracheotomy have been successfully employed 
to relieve the dyspnoea. My reply is, that the depression of the 
patient's powers was far greater than the dj^spncea, so that the 
operation would have been unsafe. That depression did not 
result from the blood being imperfectly aerated is shown by the 
depression appearing before the dyspnoea. The dilatation of 
the pupil did not depend upon the belladonna given, for it exist- 
ed as a marked symptom in every case. As regards remedies, 
I believe the tincture of sesquichloride of iron the best. The 
essentials of the disease, or the symptoms in the order they occur, 
are these : — Shivering, intense depression ; dryness and tingling of 
the throat, nares, and ears; external swelling of the glands; a 
whitish spot on the mucous membrane of the tonsil, gradually deepen- 
ing in colour as the disease progresses ; dysphagia and dyspnoza ; 
dilated pupil; impending asphyxia, and death. 

[London Lancet. 



1858.] Case of Tetanus. 839 



Report of a Case of Tetanus occurring in Bellevue Hospital under 
the care of Dr. Jas. R. Woodj Visiting /Surgeon. By J. J. 
Campbell, M.D., House Surgeon. 

Eebecca H., aged 38, pretty good constitution, but of intem- 
perate habits, was admitted into Bellevue Hospital, at 4 P. M., 
February 7th, 1858, with severe burns of both lower extremi- 
ties, caused the evening before by getting her clothes on fire. 
When admitted, she was suffering a great deal of pain, and her 
stomach was so irritable that she could scarcely retain any of the 
nourishment and stimulants that were given her. Her pulse 
was frequent and feeble, and she had slept none the night pre- 
vious. Stimulants and anodynes were given freelv, and her 
limbs were ordered to be dressed with cotton soake* in equal 
parts of linseed oil and lime water. 

Feb. 8th. Did not sleep any last night, although she had 
taken the eighth of a grain of morphine every hour since her 
admission ; her stomach still remains irritable ; her pulse con- 
tinues frequent and weak, and her limbs feel easier. Sub-nitrate 
of bismuth, opium, and a small quantity of carbonate of ammo- 
nia, ordered in pills, to be given with the view of allaying the 
irritability of her stomach. Beef tea and rare boiled eggs direct- 
ed to be taken in small quantities at a time. Stimulants and 
anodynes to be continued as before. This course of treatment 
was persevered in, but she did not improve much until February 
11th, when she was able to retain all the nourishment that was 
given to her. Her pulse still remained frequent, although it 
was stronger than when she came into the hospital. She rested 
better at night, and continued doing well in every other respect 
from this time until the morning of February 15th, when she was 
attacked with the symptoms of trismus, that I first noticed by 
directing her to put out her tongue, which she could not do to 
any extent, as she could not separate her jaws more than three 
quarters of an inch. On inquiry, I ascertained that she had 
some stiffness in the muscles of the back of the neck. I then 
desired her to swallow a little beef tea, which she did with great 
difficulty and a feeling of choking. Morphine, in half-grain 
doses every two hours, was ordered to be given, and her allow- 
ance of stimulants increased. 

At 11.30 A. M. she was seen by Dr. Wood, who directed that 
she should be put upon a stimulant, anodyne and anti-spasmo- 
dic course of treatment. Twenty ounces of brandy and a pint 
of madeira wine were ordered to be given in the twenty-four 
hours. The morphine was given pretty freely by the mouth ; 
but as she could not swallow as much of the stimulants as was 
directed, they had to be in part injected into the rectum with two 

».s. — vol. xrv. ko. v. 15 



340 Case of Tetanus. [May- 

ounces of lac assafoetida and one drachm of tincture of opium 
every two hours. She was also directed to be kept as quiet as 
possible. *Her pulse at this time was 128, quick and moderate- 
ly fall, and her respiration a little more frequent than it had 
been for a few days past. There was not much increase in the 
severity of the symptoms up to 10 P. M. At 11 P. M. she com- 
menced sleeping, and continued doing so until 2 A. M., after 
which she remained wakeful. 

9 A. M., February 16 — pulse 128, quick and moderately full ; 
respiration 24; cannot separate her jaws more than one-third 
of an inch ; has great difficulty in deglutition ; muscles of the 
neck quite rigid ; head drawn back, and does not appear to 
suffer much when undisturbed. She has had no spasms except 
of the muscles of the back of the neck. Same treatment contin- 
ued. 

6 P. M. With the exception of a little more difficulty in swal- 
lowing, is in much the same condition that she was this morn- 
ing. 

Feb. 17th, 9 A. M. Slumbered a little during the night ; 
pulse 132, quick and weak ; respiration 34 ; rigid spasm of all 
the muscles about the jaws and neck, and cannot drink from 
the feeding cup ; and all the fluid she swallows has to be inject- 
ed into her mouth with a small syringe. Her face assumes a 
livid hue during each attempt at deglutition. Has to lay on her 
side, owing to the strong contraction of the muscles on the back 
of her neck. Loud rales, produced by the air passing through 
the secretions in the mouth, can be heard while standing by her 
bedside. Her bowels moved during the night for the first time 
since the 14th. At 1.45 P. M., was seized with a convulsion 
that affected the whole body, but more especially the muscles of 
the back and neck.- Well-marked opisthotonos remains. Her 
jaws are rigidly closed, and she cannot swallow anything. At 
3.40 P. M., has had another general convulsion that lasted for 
about a minute. At 4.45 P. M., has had another convulsion like 
the two former. Pulse 120, and weak ; respiration 45, and is 
perspiring quite freely. Chloroform was tried, and the muscles 
closing, the jaws relaxed a little. From this time until twenty 
minutes of six, when she died, she had a great many convul- 
sions. Just as she was breathing her last, all her muscles became 
quite flaccid. During the two hours preceding her death, one 
ounce of the tincture of opium with very near a pint of brandy 
and wine were injected into her rectum. She remained rational 
until the last moment of her life. 

Her burns looked healthy all the time. 

Post mortem 39 hours after death. Slight rigor mortis. Some 
venous congestion of the vessels of the brain aud spinal cord. 
About two ounces of serum escaped on opening into the dura 



1858.] Tetanus relieved by Amputation. 3-il 

mater of the brain and cord. No other condition noticed in 
these parts. The right side of the heart, especially the right 
auricle, was distended with black, clotted blood, while the left 
side contained but very little. This organ felt normal. No ul- 
ceration could be detected in either the stomach or duodenum. 
The colon contained a great deal of scybalae. The bladder was 
empty and contracted. — [American Med. Monthly. 



A Case of Tetanus Relieved by Amputation. By W. W. ANDER- 
SON, M.D., ofStateburg, S. C. 

Chavis, a strong, athletic negro man, in the prime of life, the 
property of Col. Richard Singleton, in the month of January, 
18-io, was lifting a long, heavy inch plank, with a ten-penny nail 
driven to the head through one end of it. The plank acciden- 
tally slipped out of his hands and fell on his foot. The nail 
penetrated his great toe near the joint, and between the joint 
and toe-nail. The next day he went to his work as usual ; but 
a day or two afterwards his master, passing by, found him sitting 
by the road-side, and learning the cause of his leaving his work, 
ordered him to go home and poultice his foot. He did so, but 
continued to suffer considerable pain and uneasiness until the 
loth of the same month, when I was called to see him, about 
five days after the accident. I found him in pain, with symp- 
toms of approaching tetanus. An incision was made in the 
course of the wound, and spirits of turpentine applied. The 
usual remedies, such as mercurial purgatives, blisters, the free 
administration of opiates, etc., were followed up actively, but to 
no purpose. Violent spasms came on, accompanied with pain 
in the back of his neck, and constriction of his chest and abdo- 
men. The spasms increased in violence and frequency every- 
day, until the opisthotonos was so great that his head and heels 
were brought nearly into contact with each other during the 
spasms, and he was unable to swallow in the intervals of the 
paroxysms. So great were the debility and exhaustion, that I 
considered the case hopeless, and expressed this opinion to Col. 
Singleton, but said I wished to try the effects of amputation, as a 
last resort, to which he readily consented. Having only a 
pocket-case of instruments at hand, I rode to a carpenter's shop 
not far off, and borrowed a fine tenon saw, and immediately on 
my return began the operation. With a bistoury I made an 
incision around the toe, through the skin, and immediately over 
the joint, dissected up the integument, and turned it back; then 
completed the incision to the bone, and sawed it off between 
the joints, tied the artery, drew down the skin, and secured it 
with adhesive plaster, A soft compress over the stump, and 



342 Researches on the general Paralysis of the Insane. [May, 

bandage, completed the operation. After a little rest, he swal- 
lowed a large dose of laudanum, and was ordered to be kept as 
quiet as possible. I now dissected the toe, and following the 
course of the wound, found at the bottom of it, imbedded in the 
cartilage near the joint, what I at first supposed to be the point 
of the nail ; but on further examination, it proved to be a hard 
piece of black leather, which had been punched from the man's 
shoe by the blunt nail, and deposited there. No inflammation 
was apparent in the cartilage ; but there is little room to doubt 
that this minute piece of hard leather was the cause of all the 
mischief. In a short time after the operation the spasms began 
to abate, and in a day or two ceased altogether. The patient 
was now convalescent. The toe healed kindly, and the man 
recovered his usual health. I saw him from time to time after- 
wards, for several years, a strong healthy negro. 

[Charleston Med. Journal. 



New Researches on the general Paralysis of the Insane. 

This affection, which has been, for the first time, well described 
by some French physicians, among whom particularly Bayle and 
Calmeil, has lately been the object of a very remarkable inaug- 
ural dissertation by M. Linas. One of the principal questions 
examined by this young physician, concerns the nature of this 
disease. Is it the effect of an inflammation of the encephalon or 
of its membranes, as Bayle, Delaye, Calmeil, Parchappe and 
others admitted, or is it a purely nervous affection of the brain, 
as Lelut and others have maintained ? 

Already Bayle had opened one hundred corpses of paralytic 
insane, and Calmeil forty-seven. They had found the meninges 
of the convexity of the cerebal lobes opaque, injected, hardened, 
infiltrated with serosity, and offering frequently granulations or 
false membranes. M. Linas has opened one hundred and four- 
teen bodies of paralytic insane. In twelve cases he has found 
the pia-mater excessively injected. The cerebral substance was 
quite full of blood, the grey matter being from an intense red to 
a dark violet. In twenty -eight cases, besides the preceding al- 
terations, there were adhesions between the convolutions and 
the meninges. In seventy-four cases, the meninges were infil- 
trated, opaqe, and as tough as a fibrous membrane ; the cortical 
substance of the brain, sometimes violet, sometimes yellowish, 
according to the degree of the paralysis, always softened, less 
thick than in normal brains; the white substance injected, and 
sometimes infiltrated ; the convolutions me.igre, and the whole 
mass of the brain more or less atrophied. 

In thirteen cases, besides the preceding alterations, there was 



1858.] Transfusion of Blood. 843 

one or many small circumscribed places where the encephalitis 
had been more violent than elsewhere. In eight cases there 
were also effusions of blood. 

From these facts, it results positively that the paralysis of the 
insane depends upon a chronic inflammation of the brain and its 
meninges. Whether the disease begins in the membranes, as 
Bayle had said, or in the brain itself; as M. Calmeil maintains, 
is a question of comparatively little importance. The great point 
is, that the brain is always inflamed. M. Calmeil has ascertain- 
ed with the microscope, that in doubtful cases, when the brain 
did not seem to be much altered with the naked eye, there were, 
nevertheless, all the microscopical appearances of inflammation. 
M. Linas relates cases to prove, that an acute encephalitis may 
cause the paralysis of the insane. 

As regards the first symptoms of this affection, M. Linas de- 
clares, that sometimes intellectual disorders first appear, and in 
other cases, muscular paralysis and insanity appear at the same 
time. It has been said that there was always what is called by 
the French, ambitious delirium. But Parchappe, Trelat, Lasegue, 
have shown that there are exceptions to this rule, and that, there- 
fore, there is nothing specific or essential in this symptom. M. 
Linas goes farther, and he calls this opinion a paradox. Ac- 
cording to him, the delirium of paralytic insane has sometimes 
the monomaniac form, sometimes the hypomaniac, and in other 
- the maniac; but he acknowledges that ambitious ideas are 
extremely common. — [New York Jour, of J. 



ion of Blood. 

I have communicated several papers on this subject to the 
rices (see Cbmptei li Not. 185 7, p. 

925), to the Societede Biologie, and to the CercU ,ces. 

It is known that Blundell had found that a dog, bled almost 
to death, can recover, even if blood of a mammal of another spe- 
cies, be transfused into its veins; but that after a few days death 
always comes ; while the blood of another dog being employed 
for the transfusion, may reproduce a lasting life. 

Messrs. Prevost and Dumas declare also that mammals cannot 
be recalled permanently to life after a great loss of blood, if trans- 
fusion be made with blood of mammals of a species different 
from theirs. They state also, that the blood of animals transfused 
in the veins of birds, and vice verso, produces almost immediate 
death, after having caused violent convulsions. M. Eayer af- 
firms, also, that the blood of man kills rabbits, after having 
produced convulsions. DiefTenbach has sometimes seen animals 
recover after transfusion of blood of animals of other species, but 



844 Transfusion of Blood. [May, 

never when they were in a state of apparent death after a con- 
siderable loss of blood. Bischoff also has never succeeded in 
restoring to life mammals that had lost a great deal of blood, in 
transfusing blood of birds in their veins. 

An important fact, found by Bischoff, should, however, have 
opened the way to more successful results in transfusion. He 
ascertained that the arterial blood of mammals can be injected in 
the veins of birds, without killing them, while the venous blood 
causes rapid death. I have found that venous and arterial 
blood do not differ one from the other, except on account of the 
different quantities of carbonic acid and oxygen they contain. 
Both may kill, if they are rich in carbonic acid ; both may not 
have any injurious influence if they contain a great quantity of 
oxygen. Numerous experiments have led me to the following 
conclusions : 

1st. That arterial or venous blood from an animal of any one 
of the four classes of vertebrata, containg oxygen in a sufficient 
quantity to be scarlet, may be injected, without danger, into the 
veins of a vertebrated animal of any one of the four classes, 
provided that the amount of injected blood be not too consid- 
erable. 

2nd. That arterial and venous blood of any vertebrated ani- 
mal, being sufficiently rich in carbonic acid to be almost black, 
cannot be injected into the veins of a warm-blooded animal, 
without producing phenomena of asphyxia, and most frequent- 
ly death, after violent convulsions, provided that the quantity 
of injected blood be not below one -five-hundredth of the weight 
of the animal, and also that the injection be not made too slowly. 

The reasons for which Blundell, Bischoff, and others have 
failed to restore a lasting life after the transfusion of blood of an 
animal of a species different from that of the transfused one, are: 
1st, That the blood employed was not fresh ; 2nd, that it was in 
too large a quantity ; 3rd, that it was injected too quickly ; 4th, 
that it was too rich in carbonic acid, and too poor in oxygen. 
The greatest causes of failure were this last one, and after it the 
quantity of blood. 

From my experiments I have arrived at the conclusion, that 
there is no danger in employing the blood of dogs, cats, or other 
mammals in transfusion in man. Besides, I have ascertained, 
after Dieffenbach and others, that defibrinated blood is as good 
as blood containing fibrin. As regards the quantity of blood, I 
think that four or five ounces would be as much as can be need- 
ed for an adult man or woman. It is not necessary to warm the 
blood, but it may be useful to do it in some cases. The blood 
to be transfused, either that of man or of mammal, should be 
received in a large open vase, and whipped at once, then passed 
through a thick cloth. If it is not injected at once, it must be 



1858.] Indications and Treatment of Croup. 345 

either whipped again, or, at least agitated to be charged with 
oxygen just before transfusion, wh:ch can be performed with 
any kind of syringe. The injection must be extremely slow, 
and if after the injection of two or three ounces, there is 
increase in the respiratory movements, it is well to stop for ten 
or fifteen minutes before finishing the transfusion. — [New York 
Journal of Medicine. 



On Indications and Treatment of Croup. 

According to Luszinsky, of Vienna, there are four indications 
to be followed in croup, which are — 1st, to alter the peculiar 
crasis of the blood. This indication requires anaplastics, of 
which hepar sulphuris, sulphate of copper, and tartar emetic are 
either too uncertain, or too dangerous, because repeated vomit- 
ing would be injurious by congestion of the brain, and mercury, 
which readily injures by producing diarrhoea, salivation and 
general mercurialisrn. Better than all of them, are alkalies, 
which Luszinsky seems to have recommended prior to Lemaire 
and Marechal, of Paris. The hydrate of potash or soda is most 
antiplastic, but they are not easily tolerated; the bicarbonate is 
the most digestible, but the abundance of carbonic acid in the 
chemical composition of the bicarbonate of potash or soda dimin- 
ishes the medicinal effects of the alkalies; therefore he gives the 
carbonate of potash or soda, from one half of a drachm to two 
drachms every day. 2nd — To prevent the localization of the 
inflammation in the larynx. This indication requires no bleed- 
ing, nor leeches, but in the first stages of the disease, cold ap- 
plied to the laaynx, and large blistering plasters, kept in suppu- 
ration for some days. 3rd — To remove the spasm of the larynx 
by narcotics. 4th — To destroy or remove the pseudo-membranes 
which have been formed. The best caustic in these cases is a 
solution of from four to eight grains of nitrate of silver in an 
ounce of water, which is to be applied by a brush. Emetics are 
necessary, where pseudo-membranes are loose, or beginning to 
loosen, in the larynx or bronchi. — {Journal fur Kinderkrank- 
heiten, and Ibid. 



On the Abuse of Irritating Applications in certain Forms of Oph- 
thalmia. By Mr. Ceitciiett. 

There was recently a case under Mr. Critchett's care, in the 
Royal Ophthalmic Hospital, in which the greatest benefit has 
been derived from desisting from the measure which had pre- 
viously been employed. The patient is a lad of eighteen, to 
whose eyes, for four years past, stimulating drops had been daily 



346 Epilepsy treated by Ligation of Artery. P^&y, 



applied, on account of chronic inflammation and thickening of 
the conjunctiva. His eyes had been kept in a state of constant 
irritation, and when admitted his vision was very imperfect, on 
account of superficial vascularity of the cornea. He had been 
sent up from a considerable distance in the country. Mr. 
Critchett directed the eyes to be left quite alone, a single seton 
thread being introduced in each temple. The improvement 
was extremely rapid, and within a week the greater part of the 
vascularity had cleared away. No doubt the seton has had 
some good influence ; but, looking at the rapidity of the cure, it 
seems certain that the chief agent has been the rest from injuri- 
ous applications. Cases more or less similar are constantly pre- 
senting themselves, in which, with a perverseness worthy of a 
better cause, irritating collyria have been employed for periods 
far too long. — \Med. Times and Gaz., and Banking's Abstract. 



Epilepsy treated by Ligation of the Common Carotid Artery. By 
C. Angell, M. H., of Pittsburg, Indiana. 

Dr. AngRl has resorted to ligation of the common carotid 
artery on one side in two cases of epilepsy. The first operation 
was performed in July, 1857. The patient, a male, was twenty 
years of age, about five feet in height, large head, short neck, 
sanguine temperament, and of full habit. Epilepsy had existed 
for three or four years, the fits progressively becoming more fre- 
quent and severe. He had become partially idiotic. He had 
from fifteen to twenty fits during the forenoon of the day on 
which the operation was performed. The day after the opera- 
tion he complained of difficulty in swallowing, and the left side 
became incompletely paralyzed. The paralysis continued, with 
difficulty of articulation and swallowing, till the next day, when 
he died in a comatose condition. The epileptic paroxysms did 
not recur after the operation. 

The second operation occurred a few days after the first. 
The patient, a male, was forty years of age, of a full habit and 
sanguine temperament. Epilepsy had existed for seven years. 
For the last three years the paroxysms had recurred almost daily. 
The mind was much affected. He recovered from the operation 
satisfactorily, and had no return of the epilepsy for twenty- two 
days. At the end of that time he had a paroxysm on two suc- 
cessive days. Seventeen days after this a third paroxysm occur- 
red, and about a month afterwards a fourth. These four parox- 
ysms were all that had taken place up to the time of writing 
the report, a period of a little more than two months. The 
paroxysms after the operation differed from those which occur- 
red previously as regards premonitions. Prior to the operation, 



1858.] Removal of a Large Uterine Polypus. 347 

lie had no warning of their approach; but after the operation, 
a sensation of dizziness preceded the attacks for several minutes, 
giving him time to provide against falling. 

The patient declared that he felt better than at any time 
during the three years ; some of his friends thought that there 
was a decided improvement in his general appearance and men- 
tal condition. 

The report is made too recently after the operation to warrant 
any conclusion as to its permanent value in this instance. 

[Xorth- Western Med. and Surg. Journal. 



A Large Uterine Polypus removed by the Curved Ecraseur vriih 
Double Action. 

A woman fifty years of age, who had been suffering from 
frequent uterine haemorrhage during the last two years, was ad- 
mitted into the Samaritan Hospital ten days ago, under Dr. 
Savage's care. Many examinations had been made elsewhere 
previously by various surgeons ; but a polypus, if suspected, 
until the day before her admission, was probably quite out of 
reach. A swelling could even now be scarcely made out by the 
finger introduced far into the os uteri. Sponge tents were intro- 
duced daily. On the third day the tumour became more distinct, 
and then rapidly distended through the dilated os into the vagi- 
na. On the fourth day it could be felt in size and shape like a 
large jargonel pear (its neck not much less than its body,) extend- 
ing into the uterus to be attached somewhere towards its back 
part. On the fifth day the polypus was lain hold of by a pair 
of ring forceps, the loop chain of the ecraseur being passed over 
the handle of the forceps, slipped up, and was drawn tight, pre- 
cisely as the cord in the ordinary operation by ligature, and the 
tumour was brought away without pain or haemorrhage. Dr. 
Savage observed that the unwieldly look of the instrument was 
suggestive of much pain and difficulty ; but its curve fell into the 
hollow of the sacrum with the utmost facility, and its point as 
readily passed into the uterus as high as he thought necessary. 
As the chain is flexible only on one side, much careful manipu- 
lation was required before it could be got where he thought it 
ought to be. Before working the handle which tightened the 
chain, the single fore- finger readily ascertained that nothing 
improper was included. The handle was worked at half-minute 
intervals as soon as decided resistence showed that contraction 
had commenced. The tumour came away in six minutes. 
From first to last the patient said she felt no pain whatever. 
The haemorrhage has not appeared. Dr. Savage said he had 
heard of two cases of polypus thus treated in this country, but 



348 On the Functions of the Thyroid Body, [May, 

believed they had not been recorded. He had several times seen 
M. Chassaignac remove parts highly vascular with his ecraseur 
without the least hemorrhage, and thought as the plan he had 
adopted in this case was equally safe as the ligature, without any 
of its obvious annoyances, he would add his testimony to its 
value through the Medical Society. Dr. Savage strongly recom- 
mended an instrument with the double action, the finishing 
improvement of the inventor, M. Matthieu. — [London Lancet. 



On the Functions of the Thyroid Body. By Dr. P. Martyn. 

Dr. Peter Martyn has communicated to the Koyal Society 
some very ingenious speculations as to the use of this remarka- 
ble body. He first called attention to the necessity of rigidity 
in all round instructions. This is accomplished, he thinks, by 
the thyroid gland, which, being pressed upon by the muscles, 
during the act of speaking, becomes gorged with blood, and 
presses upon the larynx, rendering it tense. Furthermore, he 
believes this so-called gland acts as a loader. In musical instru- 
ments, loaders are used to render the vibrations slower and long- 
er, and the tone in consequence fuller, louder and deeper. They 
thus give to the voicing part of a small instrument the power 
and quality of a large one. The human organ of voice is only 
three inches long, and yet " has the same power as, and better 
quality of tone than, the instrument which more nearly ap- 
proaches it — the French horn — which is nine feet, or the 'vox 
humana' pipe of a moderate-sized organ, which is from four to 
eight feet long. This economy of size in the human organ has 
always been wondered at, but never, that I know, explained." 
Finally, the author of the paper believes that by the varying 
shape, bulk, destiny and pressure of this body, it aids materially 
in producing the qualities of modulation and expression belong- 
ing to the human voice. — [Amer. Jour, of Med. Science. 



Treatment of Intermittent Fever. 

There is a means of treatment of fever and ague, which is by 
far too much neglected. It consists in applications of the cold 
shower-bath a little before fever sets in. Although we do not 
admit, as it might be concluded from a paper of M. L. Fleury, 
that every case will be cured by this mode of treatment, we 
think that the facts mentioned by this able physician are worthy 
of attention. He states that he has treated, during the last ten 
years, one hundred and fourteen patients, and that they all have 
been cured, only by cold shower baths, and that there has not 
been a single return of the disease. Forty-three were recent 



1858.] Uterine Haemorrhage. 349 

cases, having existed from two days to three months; seventy- 
one were old and rebellions cases. In all these last cases there 
was an enlargement of the spleen, or of the liver, or both ; there 
was anaemia or even a cachectic state. 

One single shower-bath has often been enough to effect the 
cure. It has never been necessary to give more than five show- 
er-baths. Not only is periodical fever cured by this means, but 
all kinds of periodical affections may also be cured in the same 
way. 

When the periodical attacks are stopped, there are irregular 
ones, in most of the cases, as long as the engaged viscera have 
not been brought down to their normal volume. In these cases 
local douches have been applied twice a day, on the hepatic or 
splenic regions. — [Comptes Rendus de V Acad, des Sciences, and 
New York Journal of Medicine. 



Injection of Liquor-Ferri Sesquichlorati in Uterine Hemorrhages. 

Dr. Breslau's case of injection of liquor-ferri sesquichlorati 
shows the efficacy of this treatment in certain cases of excessive 
uterine haemorrhage. A woman, 45 years old, had worn a pes- 
sary for a long time, which she had given up on account of pain 
and hemorrhages. Examined, there were found five grape- 
shaped polypi around the os uteri, with ulceration. These were 
removed by Siebold's scissors, and potassa fusa applied to the 
ulcerations. The haemorrages remitted somewhat. The uterus 
was, however, entirely bent upon itself, and the menses returned 
in great excess. The cavity of the uterus was somewhat enlarg- 
ed. The return of the menorrhagia reduced the patient to an 
extreme degree of anaemia. Ergot of rye failed to effect any 
contraction of uterus or arrest of flooding. Two possible condi- 
tions presented themselves to Dr. Breslau: 1st, The five polypi 
attached to the cervix favored the presumption that there exist- 
ed a similar warty hypertrophy of the lining membrane of the 
uterus ; 2d, There might be a destructive ulcerative process of a 
malignant character going on in the same structure. In the 
first case, the currette of Recamier seemed indicated, in order to 
scrape the uterine membrane clean from the presumed excrescen- 
ces. In the second case, it seemed necessary to bring a caus- 
tic and styptic agent in direct contact with the diseased mem- 
brane. To answer this latter indication, he selected the liquor- 
ferri sesquichlorati of the Bavarian Pharmacopoeia. Having 
first straightened the retroflected uterus by the sound, and in- 
serted an elastic catheter as far as the fundus, he injected one 
ounce and a half of the liquor-ferri, diluted with an equal quan- 
tity of water. The injected fluid was retained in the uterine 
cavity for a minute and a half by the pressure of the fingers at 



350 Statistics of Coiling of the Funis. [^ a y» 

the os around the catheter. During the operation, the patient 
felt a dull labourlike pain which lasted for two hours. The hae- 
morrhage, which had hitherto been unintermitting, now sudden- 
ly stopped, and was not renewed. After some days, brown, 
crumbling clots were discharged, but no fluid blood. Seven 
months afterwards there had been no return of menorrhagia. 
The patient menstruated regularly every twenty-one to twenty- 
four days; and through internal administration of steel and 
quinine, recovered robust health.' — [British and Foreign Medico- 
Chirurgical Review. New Orleans Med. News and Gazette. 



Statistics of Coiling of the Funis. By Dr. Weidemann. 

Dr. Weidemann states that among 28,430 deliveries the funis 
has been found coiled around the child in 3,379 instances. In 
3,230 of these it was coiled around the neck, and in 149 around 
other parts of the body. Of the 3,230 cases, 2,546 consisted in 
a simple coil, and in 684 there were severe coils. In relation to 
the causes of this occurrence, it is interesting to notice that of 
1,788 cases occurring at the Marburg Midwifery Institution, the 
funis was in 80 (1:22.2) under 15 inches, and in 183 above 25 
inches (1:9.71) in length ; that in 54 (1.33) there were very little 
liquor amnii, and in 41 (1:43.6) there was very much; in 165 
(1:10.8) the child was under 5 pounds weight, and in 28 (1:61.7) 
it was 8 pounds. Therefore, among the favoring causes of the 
occurrences may be mentioned a long funis, abundance of liquor 
amnii, and a small child. 

Among 2,930 infants born at Marburg, 182 (1:16.09) were 
dead, 251 (1:12.41) were still-born. Of 725 born with coiled funis, 
45 (1:16.11) were dead, and 72 (1:10.%) were still-born. Of the 
45 dead-born, in 18 only could the death be referred to this alone, 
i. e., only 1:40.2 in the 725 examples of coiling. From an ex- 
amination of the figures derived from the midwifery institutions 
at Dresden, Gottingen, Wiirsburg, Berlin, and Marburg, it re- 
sults that of 13,720 new-born infants, 902 (1:15.21) were born 
dead ; while in the 1,217 instances of coiling of the funis, 31 
children were born dead, whose death could be attributed to that 
circumstance, giving a proportion of 1:39 to the coilings, and 
1:19 to the number born dead. 

Thus, as (1) the 16th child among new-born children in 
general, as well as among those in which coiling has taken place, 
is born dead ; as (2) the 12th child among the new-born in gen- 
eral, and the 10th among those around whom the funis is coiled 
is born still-born ; and as (3) in one child in 40 only can this 
coiling be regarded as really the cause of death, it is evident that 
this accident does not occupy a very prominent place. — [Monatsch. 
fur Geburtskunde, and Med. Times and Gaz. 



1858.] Case of Diabetes Traumaticus. 351 

Case of Diabetes Traumaticus. Translated for the Charleston 
Med. Jour, and Review. 

Dr. Herman Itzigsohn reports the following case in Virchmtts 

Archiv, for April 1857: A Mechanic, aged thirty-eight years, 
unmarried, previously in good health, received a year ago, a 
blow from the blade of a hatchet on the top of the head, a little 
to the left of the median line. He immediately suffered from 
incontinence of urine ; but he could void it copiously on making 
a strenuous effort. Gradually diabetes manifested itself. Inor- 
dinate thirst supervened, the patient drinking sixteen quarts of 
fluid daily, which naturally produced a corresponding flow of 
urine. He dieted himelf on bacon, which he craved more than 
any other kind of food. At this time yellow discoloration of 
the conjunctivas announced disorder of the liver, which condi- 
tion was further indicated by swelling and uneasiness in the 
hepatic region. 

This case is in two respects worthy of notice : firstly, for its 
traumatic origin ; secondly, for the tardy appearance of the liver 
affection. In accordance with Bernard's theory, it may be sup- 
posed that a splinter of bone was driven into the fourth ventricle, 
or that an extra vasated clot occurred there ; although it is not 
probable, as there was not the slightest appearance of the brain 
being injured, either by shaking of the head, or any other 
irregular movement ; neither was there vertigo nor headache at 
any time. It remains yet to be proved whether diabetes is to 
be traced primarily to a diseased brain, and secondarily to the 
liver, or not. The expression of opinion is desirable on so im- 
portant a question. 



Condition of the Nerves in Degenerated Tissues. Translated for 
the Charleston Med. Jour and Review. 

In Yischow's Archiv, Band XL, Heft 2, p. 200, we find the 
following summary of the researches of Fred. Marfels. The 
author examined the condition of the nervus vagus in four 
human subjects, the victims of pulmonary phthisis and maras- 
mus. He ascertained that the fatty degeneration does not attack 
the nerves immediately; but that the metamorphosis begins 
in developement of cells, which in the nerve fibres itself should 
normally proceed. He describes the same as nucleus-holding 
cells of the size of the small colorless blood corpuscles, which lie 
in the midst of the fibres, for the most part without any interven- 
ing granular substance ; and, strange to relate, he finds that 
neither potash, ether, nor iodine decompose them. Once when 
examining the ischratic nerve, he found these cells even inside 



352 Calcareous Salts in the Treatment of Rickets. [May, 

the axis cylinders, which observation corresponds with the dis- 
covery made in some of the lower animals of the existence of 
cells in the nerves, partly granulated and non-nucleated, and 
partly transparent, clear and nucleated, strung together in the 
central cord of the nerves. The author did not find nuclei in 
the sheath of the primitive nerve-fibres in man ; but in animals 
he thinks he saw them, where the nerve-sheaths appear to be 
filled by these fibres. Twice he observed the escape of the nerve 
contents from the sheath, when at the same time he saw the 
above alluded to cells. 



Calcareous Salts in the Treatment of Rickets. 

Dr. W. Budd, of the Bristol Koyal Infirmary, states (British 
Medical Journal, Jane, 1857, p. 514) that he has derived better 
results, in the treatment of rickets, from the compounds of lime, 
than from any other remedial means. In cases short of rickets, 
too, where children with large heads, tumid bellies, and pasty 
complexion, whose spines are too weak to support their bodies, 
who are slow in intellect, and backward in teething, and have 
reached the age of eighteen months or more, without showing 
any desire to take to their feet, the beneficial influence of calca- 
reous compounds is equally manifest. In such cases, Dr. Budd 
gives five or ten grains of phosphate of lime, in chalk mixture, 
thrice daily, adding a simple chalybeate if anosmia is palpably 
present. At the end of a fortnight, the improvement of the 
patient is generally conspicuous. Dr. Budd believes that the 
deterioration in the teeth of the rising generation is due to the 
insufficient supply of the inorganic constituents of these organs 
in the food of children, and suggests that children in cities 
should be fed, in part, during dentition, on biscuits containing 
a proportion of salts of lime. — [Virginia Med. Journal. 



On Lead Colic. By M. Briquet. 

Avery interesting communication has been made to the Aca- 
demie de Medicine, by M. Briquet, physician of the Cbarite 
hospital. The object of the paper is the nature and treatment 
of lead colic. What is the seat of the violent pain which then 
exists f Is it the digestive canal — the muscles of the abdomen — 
the diaphragm ? Is the spinal cord affected, as Laennec and 
Barbier admitted? Is the pain purely neuralgic, as maintained 
by Andral and Grisolle? M. Briquet affirms, from researches 
made on forty-four patients, that the pain is in the muscles of 
the abdomen, sometimes in one, sometimes in many. He says 
also, that there is in some cases a real hyperesthesia of the skin 



1858.] Editorial and Miscellaneous. 353 

in the neighborhood of the painful muscles. In some patients, 
however, the reverse exists : the skin is anaesthetic. He affirms 
that constipation has no influence whatever on the abdominal 
pain. He proposes in another paper to relate cases to prove that 
the application of galvanism to the painful muscles usually takes 
away the pain at once. We can assert that it is perfectly true 
that the pain may disappear immediately in cases of lead colic, 
after one application of an electro-magnetic current. — [Ibid. 



EDITORIAL AND MISCELLANEOUS. 

Editorial. — On account of the space occupied this month by an un- 
usual amount of original matter, and the space given to the minutes of 
the State Society, our Editorial matter must be deferred for the next 
month. 



Minutes or the Annual Meeting of the State Medical Society. 

Madison, April 14th, 1858. 

The Society assembled at 10 o'clock, in the Town Hall, in Madison, 
and was called to order by the 1st Vice-President, Dr. H. F. Campbell, 
of Augusta. 

The following regular members were present : — Drs. J. G. Westmore- 
land, M. H. Oliver, John W. Jones, T. C. H. Wilson, Thos. S. Powell, 
W. T. Hollingsworth, W. S. Meiere, Jos. P. Logan, A. Means, V. H. 
Taliaferro, G. L. McCleskey, Henry F. Campbell, Eben. Hillyer, J. K 
Simmons, Juriah Harriss, E. E. Jones, DeSaussure Ford, S. G.Anderson, 
Win. Louis Jones. 

The minutes of the last annual meeting, held in Augusta, April 8th, 
1857, were read and approved. 

The rules were suspended, and upon written application, the following 
gentlemen were duly elected members of the Society : 

R. T. Pulliam, A. J. Shaffer, J. N. Coe, L. J. Green, A. M. Parker, 
Isham 'H. Ragan, J. H. Conaly, F. S. Colley, S. J. Saffold, L. T. P. Har- 
well, L. G. Anderson, J. M. Boring, R. J. Stewart, S. H. Dean, S. H. 
Smith, L. S. Means, A. M. Boyd, W. F. Westmoreland, H. W. Brown, 
B. M. Smith, H. J. Walker, Wm. H. Philpot, Wm. B. Crawford, Gasby 
Night. 

The election of officers being next in order, a ballot was ordered, and 
the following gentlemen were elected for the ensuing year : 

Dr. J. P. Logan, of Atlanta, President ; Dr. H. J. Ogleby, of Madison, 



354: Miscellaneous. [May, 

1st Vice-President; Dr. John T. Banks, of Zebulon (Pike county), 2nd 
Vice-President ; Dr. Eben Hillyer, of Rome, Treasurer and Secretary. 

On motion, a committee of two were appointed to conduct the Presi- 
dent elect, Dr. Joseph P. Logan, to the chair ; which being done, he 
returned his thanks to the Society, in a few appropriate remarks, for the 
honor conferred upon him. 

Dr. E. H. W. Hunter, of Louisville, was, by ballot, elected to deliver 
the Oration at the next annual meeting. Dr. G. L. McCleskey, of Mad- 
ison, as his alternate. 

The selection of delegates to the American Medical Association being 
next in order, a committee of five, consisting of the following gentlemen, 
were appointed to nominate them, and report at their earliest conven- 
ience :— Dr. Ford, Dr. Harriss, Dr. W. F. Westmoreland, Dr. Simmons 
and Dr. Boyd. 

Society then adjourned until 2 o'clock P. M. 

AFTERNOON SESSION. 

Society called to order by the President. 

Dr. Hillyer, by appointment, read an essay upon the Physiology of 
Menstruation. 

The committee to appoint delegates to the American Medical Asso- 
ciation, reported the names of the following gentlemen : — Juriah Harriss, 
of Savannah ; W. T. Hollingsworth, of Morgan ; F. S. Colley, of Wal- 
ton ; W. G. Bulloch, of Savannah ; H. F. Campbell, of Augusta ; H. M. 
Boyd, of Cave Spring ; Eben. Hillyer, of Rome ; B. M. Smith, of Atlanta ; 
C. B. Nottingham, of Macon ; R. Q. Dickinson, of Albany ; E. M. Pen- 
dleton, of Sparta ; James Green, of Macon ; J. F. Banks, of Zebulou. 

The essay of Dr. Meiere being called for, he responded in a very inter- 
esting article upon the use of Alcohol in Typhoid Fever. 

Society adjourned till 7 o'clock P. M. 

Society met, pursuant to adjournment. 

Dr. W. F. Westmoreland moved, that the mode of appointing Essay- 
ists and subjects be changed. That each gentleman appointed be allow- 
ed to write upon any subject of his own selection. 

Upon motion, Drs. Campbell, E. Jones Oliver, W. F. Westmoreland, 
and Dean, w r ere appointed a committee to nominate Essayists for the next 
meeting. 

The report of the late Treasurer, Dr. Nottingham, for the years 1856- 
185V, were received and adopted. 

A ballot was ordered, to determine upon a point for the next annual 
meeting, which resulted in the selection of Atlanta. 



1858.] Miscellaneous. 355 

Dr. J. G. Westmoreland moved, that two hundred copies of the Con- 
stitution, By-Laws, Roll of Members, (fee., be ordered to be published in 
pamphlet form, for distribution among the members of the Society. 

Dr. Meiere moved, as a substitute, that all the medical journals in the 
State be requested to publish the Constitution, &c, in their columns — 
which substitute was carried. 

The Committee on Essays reported the names of the following gentle- 
men, as Essayists for the next annual session of the Society : 

Dr. H. W. D. Ford, Dr. H. F. Campbell, Dr. Robert Campbell, Dr. 
Smith of Griffin, Dr. E. Hillyer, Dr. Stewart of Pike county, Dr. G. B. 
Night, Dr. S. H. Dean, Dr. W. F. Westmoreland, Dr. W. H. Doughty 
of Augusta, Dr. Juriah Harriss, Dr. J. G. Howard, Dr. R. D. Arnold, 
Dr. V. EL Taliaferro, Dr. Joseph A. Eve, Dr. A. M. Boyd, Dr. Joseph P. 
Logan, Dr. H. W. Brown, Dr. J. M. Green, Dr. T. B. Ford, Dr. G. L. 
McCleskey. 

On motion of Dr. Means, it was passed, that the report of any inter- 
esting case, or other communication, would be gladly received from any 
gentleman by the Society. 

The following report was received from Drs. Bulloch, and Arnold, a 
committee appointed by the Savannah Medical College, to solicit the 
co-operation of the Society in procuring the legalization of dissections, for 
medical and surgical purposes, and the modification or repeal of the laws 
now in force against it : 

To the President and Members of the Medical Society of the State of 
Georgia : 

Gentlemen — We, the undersigned committee, have been appointed 
by the Faculty of the Savannah Medical College, and instructed to con- 
fer with you, asking your concurrence in a movement having for its 
object the passage of a law by the Legislature of Georgia, legalizing dis- 
section for the purposes of medical and surgical study. 

To effect this great object, we would most respectfully solicit the So- 
ciety to unite w T ith us in a petition to the Legislature, at their next session, 
to pass an Act rendering it lawful for the Professors and Teachers in 
Medical Colleges and Schools in this State, to receive for Anatomical 
study the unclaimed bodies of persons dying at public hospitals and other 
kindred institutions. Such a law is in force in other States. 

Accompanying this, will be found a copy of the Statute enacted by the 
Legislative Assembly of the State of New York. 

The New York law concedes, as you will observe, very little else than 
the single point of legalizing dissection. Even this may be of immense 
practical service, by ridding us of the annoyance to which we may be at 
any time exposed, whilst the possession of a dead body, even for scientific 
purposes, is, according to the existing law, equivalent to a crime to which, 
evil disposed persons might at any time call public attention. 

Is it not the bounden duty of the State to see that the Medical Profess- 
15* 



356 Miscellaneous. [^ a 7» 

ion of the land, who are the true missionaries to suffering humanity, lack 
nothing needful for their efficiency and usefulness, without the necessity 
of going out of the State to obtain this knowledge — not forgetting that 
it is this profession alone that can be brought to bear on the waste of 
human life. 

The public demands that the medical institutions shall furnish it with 
good and accomplished physicians and surgeons, yet it has set its face 
against the only means of obtaining them. But at the present time, un- 
der its present prosperity and attainment, there is that advancement made 
in other branches of learning and science — there is that enlightened poli- 
cy in legislation upon all matters of general interest and improvement, 
that we have a right now to expect and to ask for some measure, some 
means, whereby we can procure material for dissection in some legitimate 
manner, that we may be enabled to make that progress and advancement 
in our profession that will raise it to that rank and standard it so nobly 
bears in other sections of our land. 

We wish to be relieved from this false and dangerous position that 
affixes upon us the stigma of felons, in the acquisition of anatomical 
knowledge, and all these difficulties and excessive annoyances under 
which we are laboring, and which we are now obliged to encounter and 
overcome, to make that progress and advancement in our profession that 
operates only to favor our more faithful discharge of duty. This is not 
for the exclusive advantage of me medical man : it seeks no other benefit 
than that which it wishes all others to enjoy : it is for the common good. 
Every intelligent man, whether professional or non-professional, cannot 
but admit that the interests of society imperatively demand the study of 
practical anatomy. Then why should not the State make a suitable 
arrangement by law. Is there any reason why we should stand in this 
matter behind New York, Massachusetts, Michigan, and many other 
states, in an enlightened policy. Considering the rights of the medical 
profession, in the just and proper estimate of its value, and in comparison 
with the privileges that are extended to it in other states, let there be 
removed from our Statute books those laws repressing the study of Sci- 
ence — laws that should exist only in darker ages — that now put a barrier 
in the way almost ruinous to the pursuit of anatomical investigation, and 
continually threatens and exposes us to a most disgraceful and ignomini- 
ous punishment ! 

We would prefer securing the passage of a more liberal law than that 
of the New York Act, so that if our views on this subject accord, any 
petition your honorable body may think proper to make, calculated to 
facilitate the passage of a bill, through the Legislature, would meet our 
hearty concurrence. 

WM. G.BULLOCH, M.D. 
R. D.ARNOLD, M.D. 

The following was passed, offered by Dr. Taliaferro, of Atlanta : 

Resolved, That the thanks of this Society be tendered to Col. C. R. 
Hanleiter, editor of the National American, for his presence on this occa- 
sion, and for the interest he manifests in the elevation of Medical Science, 
by the exclusion from the columns of his paper, the advertisement of all 



1858.] Miscellaneous. 357 

quack medicines, secret remedies and criminal drugs, which too frequent- 
ly pollute the public press. 

The following, passed, offered by Dr. Dean : 

Resolved, That the thanks of this Society be tendered to the town 
authorities of Madison, for the use of their Hall — to the Trustees of the 
Presbyterian Church for the use of their Church building — to the Physi- 
cians and citizens, for their courtesy and attention to the members of this 
Society. 

The following letter, to the Society, from Dr. Arnold, was presented 
and read by Dr. Harriss : 

Savannah, April 11, 1858. 
To the Officers and Members of the Med. Society of the State of Georgia : 

Gentlemen — My engagements with Savannah Medical Journal have 
prevented, and will prevent me from fulfilling the appointment of the 
Society, in writing an article on the Pathology and Treatment of Yellow 
Fever. I think I can do the subject more justice, in carrying out the 
plan I have formed, of giving in successive numbers of the Journal a full 
history of our terrible epidemic of 1854, for which my notes taken at the 
time are ample. 

I respectfully request to be discharged from the further consideration 
of the subject. 

Respectfully yours, 

R. D.ARNOLD. 
The request of Dr. Arnold was granted. 
On motion, the following was passed : 

Resolved, That this Society do now adjourn, to reassemble in the city 
of Atlanta, on the second Wednesday of April, 1859. 

EBEN. HHLYER,M.D., 

Secretary. 



New Febrifuge. Azderach Bark. — Dr. W. R. Cornish, of the Bengal ar- 
my, (Indian Annals of Med. Science, Oct. 1856,) states that the Margosa 
or Neem tree has long enjoyed a considerable reputation in India as a 
febrifuge, and that it belongs to the natural order Meliaceae and genius 
" Azadirachta." It is probably the Melia Azederach of our Pharmaco- 
poeia, and which under the name of Pride of India is so extensively em- 
ployed as a shade and ornamental tree in the Southern States. Here the 
bark is used as a vermifuge. Dr. C. describes the bark as being nearly 
white internally and purple externally. When chewed, in its recent 
state, its taste is at first sweetish, followed quickly by a powerful and 
lasting bitter. Dr. C. employed the bark during six months with nearly 
all the fever patients that came under his care, in the form of decoction, 
(the strength of which is not given,) from one to two wine-glassfuls being 
administered repeatedly before the accession of the paroxysm. Dr. Cor- 
nish considers that the active principal resides more especially in the light 
colored inner bark, the dark exterior being highly astringent, owing to a 
tannin analogous to that in catechu. — [American Jour, of Pharmacy. 



858 Miscellaneous. P^ a y> 

Ampelopsis Quinquefolia, or Virginia Creeper. — The common Am- 
pelopsis, or Virginia Creeper, so ornamental as a deciduous climbing plant 
in our woods and on many; walls in this city, is recommended by Dr. J. 
McCall as a remedy in dropsy. The bark of the vine is the part employed, 
and it should be gathered late in the Autumn, w T hen the berries are fully 
ripe and the leaves begin to turn red and fall. It should be dried in the 
shade and preserved carefully from moisture. The Ampelopsis is readi- 
ly known by the quinate division of the leaf. Its creeping character and 
frequent occurrence on the same tree with Rhus radicans, or poison vine, 
should lead the collector to avoid substituting the latter, which has a 
three-lobed leaf. 

In its physiological effects it appears to " stimulate absorption and the 
elimination of matter through all of the outlets of the system rather than 
to act on any particular secretion, though by some it is stated to be ac- 
tively diuretic." 

Dr. McC. esteems the Ampelopsis a valuable addition to the materia 
medica ; it is not unpleasant to take, though in taste it is acrid and 
persistent. Its infusion and decoction are quite mucilaginous. — [Mem- 
phis Jour, of Medicine. 



Cancer in a Woman aged Eighty Years. Soap and Lead Plaster in 
Schirrus. — The same day that we saw the foregoing cases, w r e observed 
a woman, eighty years of age, at the Cancer Hospital, with well-marked 
scirrhus of the left breast, which appeared about a year ag*o. Notwith- 
standing her great age, she had the blooming, healthy cheeks of a country 
girl of eighteen ; her general health was perfect, and under the use of 
tonic remedies, and soap and-lead plaster spread on leather, with a little 
camphor, the cancer has diminished in size, and its progress is complete- 
ly arrested for the piesent. This is by no means an exceptional case of 
the arrest of the progress of cancer at this hospital ; for we have observed 
several in whom the disease has been kept stationary for years, with no 
other inconvenience than the presence of the tumour in the breast, and 
the knowledge on the part of the patient that it was still there. The 
soap-and-lead plaster is one of the principal agents in effecting this desi- 
rable object ; the lead appears to possess some peculiar influence in the 
disease. — [London Lancet. 

Powdered Chlorate of Potash as an Application to Ulcers, etc. — For 
some time past, at the Metropolitan Free Hospital, Mr. Hutchinson has 
employed the powdered chlorate of potash as an application to cachectic 
ulcers. In most cases it appears to exert a very beneficial influence, 
speedily inducing cicatrization ; and it is very convenient of use. The 
cases in which it has best suited have been some of ulcers of the leg, 
open buboes, simple sores on the skin of the penis, and cracked nipples. 
In the latter it answers admirably. The salt should be powdered very 
fine and dusted into the sore with the finger. It produces sharp smarting 
for a short time, but the pain soon subdues. In most cases suitable for 
its use it is also desirable to prescribe its internal administration; but 
with a view to making the experiments more conclusive, in the cases 
upon which Mr. Hutchinson founded his opinion of its efficacy, no other 
treatment was adopted. — [lb. 



1858.] Miscellaneous. 359 



Ulcerated Larynx in Typhoid Fever, Producing General Emphyse- 
ma. — It was thought to exemplify an occasional complication of ty- 
phoid fever. The ease was one of a boy who lately died under Dr. Ad- 
dison's care, at Guy's Hospital. About the twelfth day of his illness his 
neck was observed* to be emphysematous, and in a few hours the face, 
arms, chest, &c, were in a like condition. This continued for ten davs, 
when he died. Besides the usual affection of the ileum, there was found 
at the back part of the larynx a sloughing ulcer, which communicated 
with a space between the oesophagus and trachea. Through this line 
the air had penetrated into the mediastinum, and so to the general sub- 
cutaneous tissue of the body. Considering the rarity of emphysema from 
such a cause, the case might be thought to be unique or accidental, but 
(Dr. Wilkes believed) for various reasons, it was probably not so. In the 
first place, emphysema had been alluded to by various writers as an occa- 
sional occurrence in typhoid fever, though the cause was unknown ; and 
secondly, a peculiar disease of the larynx had been described by various 
pathologists as a part of typhoid fever. In all probability, then, these 
two affections stood in the relation of effect and cause, and, therefore, 
although this was the first case of the kind he had witnessed, it afforded, 
in all likelihood, an explanation of an occurrence which rarely, though 
sometimes, happens in the course of typhoid fever. — [lb. 

A Venereal Badge. — M. Renaud states the following fact in a feuille- 
ton of the Gazette des Hopitaux : — In Servia, a woman who is found to 
be suffering from syphilis, can claim admission into an hospital, or has 
the privilege of being treated at home by any medical man she chooses 
to call in. When she is attended at her own residence, she is obliged to 
wear a necklace fastened in front with a seal, which must be broken be- 
fore the necklace can be removed. The clandestine breaking of this 
seal is severely punished ; and any one coming in contact with the woman 
thus marked, must plainly see in what state of health she is. It is to be 
regretted that like measures are not in force in other parts of the East, 
where prostitution is carried on without any control. — [lb. 

Case of Congenital Hypertrophy of the Tongue, and Amputation. — 
This case was reported by Dr. Morrogh, of New Brunswick, X. J., and 
occurred in a girl seven years old. At birth the hypertrophy was moder- 
ate, but it had increased more or less rapidly till reaching its present 
dimensions ; the tongue was found protruding two inches outside the 
jaws. It measured two inches across the teeth, and was of a corres- 
ponding thickness. The papilla? of the protruded portion were enlarged, 
and the mucous membrane was thickened and indurated. On the under 
surface was a ragged, hard ulcer, produced by the pressure of the teeth. 
These were pressed forward considerably out of their natural position. 
The horizontal rami of the inferior maxilla were curved downwards so 
that, when the molar teeth came in contact, a space of about one inch 
remained between the upper and lower incisors. By this the girl was 
enabled to masticate and swallow without difficulty. After theexample 
of Dr. Harris, of Philadelphia, who, after endeavoring to amputate in a 
similar case by ligature, in 1829, performed the same operation, in 1835 
by a double flap incision, checking the hemorrhage by ligature, Dr. Mor- 



360 Miscellaneous. [May, 

rough operated by removing a V shaped portion from the anterior mid- 
dle part of the tongue, and ligating the ranine artery. Although copious 
hemorrhages followed, the patient went home well, on the sixth day after 
the operation. — [Medical and Surgical Reporter. 



Transcendental Medicine; the Divine Unconscious. — It is not man 
who cures disease by means of his conscious spirit ; but it is the divine 
Unconscious in man. The same power which fashions his organism, and 
daily recreates it in depths of mystery, is alone that which brings him 
back from sickness to health ; and all that man's inventive mind has 
learnt in the healing art, for long centuries, limits himself to providing 
means to facilitate, to further, and in general, perhaps, to render possible, 
the task of this divine Unconscious. . . We cannot, by an immediate ex- 
ercise of skill, cure the most trivial cut of the finger ; the healing of even 
such a wound as this depends on a formation of new organic substance, 
of which formation the divine Unconscious is alone capable; at most we 
can either hinder or further this process, and in the accomplishment of 
the latter aim lies the essence of the surgical art. — [Dr. C. G. Carus : 
Ueber Lebanmagnetismus. London Lancet. 



Slitting up the Lachrymal Canals. — The practice of slitting up the 
lachrymal canals and their orifices, originally introduced by Mr. Bow- 
man, for the treatment of certain cases of epiphora, still continues to be 
extensively employed at the Moorfields Ophthalmic Hospital. It is adapt- 
ed to all cases in which either the punctum is narrowed or displaced 
outwards, and these constitute a very numerous class. In almost all 
cases of long-continued tinea tarsi, in which, by degrees, the thickening 
of the lower Jid has everted its edge, this simple procedure relieves the 
patient of his most troublesome symptom. Mr. Critchett has recently 
had made some grooved steel probes for this operation, which materially 
facilitate its performance. The silver ones formerly employed being 
necessarily very small, were unsteady as guides to the point of the knife. 
The steel ones, on the contrary, give it good support, and their groove 
is of great advantage in securing that it shall glide easily in the right 
direction. To secure smoothness of surface, and prevent rusting, the 
steel probes are gilt. A Beer's knife is the best, and with these instru- 
ments the operation is one of extreme ease. — [Med. Times and Gazette. 

Rules Respecting the Treatment of Primary Syphilis. — It seems to be 
now pretty generally acknowledged, in hospital practice, that mercury 
should be given only in those cases in which the chancre presents marked 
induration, and that in all others secondary symptoms should be waited 
for before having recourse to specific treatment. In a large majority of 
sores not attended by induration, no constitutional phenomena will follow ; 
and to discriminate'between those likely to be so followed and the harm- 
less class, is admitted to be impossible. There is, therefore, no altera- 
tive, except we would give mercury very often unnecessarily, but to wait 
in these cases until the real nature of the affection shall have been made 
manifest. In the non-indurated class, local stimulants, as sulphate of 
copper, lunar caustic, or the acid nitrate of mercury, are the oldand 
«ttll favorite remedies. If the chancre be seen within a week of its origin, 



1858.] Miscellaneous. 361 

whether induration have already commenced or not, vre believe most sur- 
geons would destroy it freely either by nitric acid or some other caustic. 

[Med. Times an:! Gazette. 



New Antiperiodic. — Dr. R. S. Cauthorn, of Richmond, Va., gives an 
account of the root of Apocynum Cannabinum, as a powerful antiperio- 
dic. This power of the root was discovered by an herb doctor, by the 
name of Ragland, and the medicine is called "Dr. Raglard's Root of 
Man" by the people who had used it. About six grains of the root is 
administered in the form of powder or pills, preceded in cases of ague 
by a dose of calomel. Dr. Cauthorn expresses much confidence in the 
virtue of the Apocynum Cannabinum, and he may be correct in his infer- 
ences ; but as his own observations were only extended to six cases it may 
be well to get further information before admitting it to the rank claimed 
for it by Dr. Cauthorn, which can readily be effected, as the plant is 
found all over the Middle States. — [Richmond Stethoscope. 



Corrosive Sublimate and Collodion as an Escharotic. — Dr. Macke uses 
a solution of a drachm of corrosive sublimate in an ounce of collodion 
as an eschrrotic to remove small exerescences, which it is desirable to get 
rid of without using the knife. It is applied by means of a camel's hair 
brush. When the inflammation is high, it may be abated with cold 
water applications without interfering with the action of the caustic, the 
eschar is then thrown off in from three to six days, with slight pain, and 
the author has not noticed absorption to take place during its contact. 

[Hay's Journal. 



Gelatinized Chlorform. — Dr. Massart (Revue de Therapeutique) gives 
the following process for making chloroform jelly for facilitating its use 
as a local anaesthetic, viz : Take equal parts of white of egg and chloro- 
form, shake the mixture and let it stand for three hours. Or take one 
part of white of egg and four parts of chloroform, put them in a bottle, 
which is then plunged in a water bath of the temperature of from 120° 
to 140° Fahr., when gelatinization occurs in four minutes. This prepara- 
tion is applied by rnbbing the painful part, and its power of affording re- 
lief is said to be remarkable. Dr. Massart prefers the cold process. If 
allowed to remain long in contact with the skin, it produces incipient 
cauterization. — [Boston Med. Journal. 

Foul Ulcers of the Legs. — A woman at St. Mary's Hospital, whose 
entire leg had been in a state of ulceration for years, with islands of skin 
here andthere, has had it effectually healed up, by Mr. Coulson, by wrap- 
ping a piece of linen around it wet with a lotion of the sulphate of soda, 
and a bandage over all. Mr. Coulson thinks the bandaging and rest have 
proved as serviceable as anything else used. — [Ibid. 

Yeast in Scarlet Fever. — Some years ago my attention was directed 
to the use of yeast in scarlet fever, by an article in your Journal from the 
pen of Dr. Smith, of Baltimore. I have given it this last winter in fifty- 
three cases, and all have recovered. These were all the cases in my 



362 Miscellaneous, 

practice. Together with the yeast, inunction has been employed in two 
thirds of them. 

I believe that the free use of yeast may prevent a bad type of the dis- 
ease. It was given, at the outset, every two or three hours, in doses from 
a teaspoonful to a tablespoonful, and continued until desquamation. 

[A. S. McClean. Boston Med. and Surg. Journal. 

Poison Census. — The Medical Times states, that in the four years, 
from 1848 to 1851, the deaths by poisoning ranged from 444 to 447 each 
year. In the three subsequent years, 52, '53, and '54, the number of 
deaths by poisoning was 370, 409, and 398. This decrease is attributed 
by Dr. Farr, to a certain extent, to the effect of the Legislative restrictions 
from the " Sale of Arsenic Act." — [Druggists Circular. 

Edinburgh Celebrities from an American Point of View. — Dr. Simp- 
son, a short thick man, with what General Massey calls "body of Bac- 
chus and the head of Jove," really a very fine head, covered with long 
black curls, seamed with gray, a round Scotch face, high cheek-bones, 
penetrating mild eyes and curious prim mouth, deep sunk between the 
nose and chin, like that of Cicero. And there is no reason why it should 
not, for the doctor, too, is eloquent in his own sphere. He persuades 
nervous females into good health, and amuses all by his genial humour 
and stories. He is a bold experimenter, and has hit upon other things 
than chloroform. Many tales of his benevolence are told. The poor 
never apply to him in vain. Not a few of his own profession envy him, 
and assail his reputation for the love of novelties, etc.; while, on the other 
hand, the disciples of mesmerism and the water cure declare he could 
say something in their favor, if he had the courage and the good will.— Pro- 
fessor Syme, the first operator alive, is a clean made, gentlemanly man, 
with a finely formed, baldish head — a most concise, decided individual, 
sharp, curt, and unceremonious as his own knife, but always going direct 
to the heart of the matter, never wasting a drop of blood or a drop of ink, 
or a single word. He is not much addicted to giving drugs. He likes 
to see what he is about, and has no fancy for poisoning people at random 
with the preparation of chemistry. — A colleague of these two, and an 
opponent of the former in reference to homoeopathy warfare in Scotland, 
a tall, compact, swarthy, bushy-haired man, dexterous at controversy, 
and capable of making a clear extempore statement, in a style that many 
lawyers would envy. — [Scottish American Journal. 

Wendell Holmes on Controversy. — " If a fellow attacked my opinions 
in print would I reply ? Not I. Do you think I don't understand what 
my friend, the professor, long ago called the hydrostatic paradox of con- 
troversy? Don't know what that means? Well, I'll tell you. You 
know that if you had a bent tube, one arm of which was the size of a pipe 
stem, and the other big enough to hold the ocean, water would stand at 
the same hight in one as in the other. Controversy equalizes fools and 
wise men in the same way — and the fools know it." 

The London Lancet says " that Quacks bear the same relation to the 
Medical Profession, with that of the pediculus to the human being on 
whom it preys." 



SOUTHERN 

MEDICAL AND SURGICAL JOURNAL. 

(NEW SERIES.) 



Vol. XIV.] AUGUSTA, GEORGIA, JUNE, 1858. [No. 6. 

ORIGINAL AND ECLECTIC. 

ARTICLE XIV. 

Observations on Malarial Fever. By Joseph Jones, A.M., M.D., 
Professor of Physics and Natural Theology in the University 
of Georgia, Athens ; Professor of Chemistry and Pharmacy in 
the Medical College of Georgia, Augusta ; formerly Professor 
of Medical Chemistry in the Medical College of Savannah. 

PRELIMINARY OBSERVATIONS. 

In the present state of Medical Science, the complete investigation 
of all the effects and phenomena of 'disease, is impossible. 

Imperfections in our instruments ; imperfections in our methods 
of analysis and the complicated nature of the phenomena, render 
physiological and pathological investigations difficult and uncer- 
tain. 

The truth of this assertion may be established by an examina- 
tion of the relations of animated beings to exterior inorganic 
bodies, to each other, and to the physical and chemical forces. 

Organized animate bodies are composed of inorganic elements, 
and are governed by all the laws and phenomena of inorganic 
bodies, and are absolutely dependent, for their existence, upon 
inorganic bodies. They have, however, a new set of phenome- 
na, dependent upon the vital force; and in animals we have 
another set of phenomena, dependent upon the existence of the 
nervous system and intellectual faculties; and in man we have 
another set of phenomena, dependent upon the combination of 
the intellectual with moral faculties. 

K. S. — VOL. XIV. KO. VI. 16 



364 Jones, on Malarial Fever. [June, 

Inorganic bodies, with their properties, form the necessary 
conditions for the existence of plants and animals, just as the 
properties of cohesion nnd gravitation form the essential condi- 
tions for the existence of the universe, in its present arrange- 
ment. 

The phenomena of living beings, plants and animals, are 
therefore more complicated, and less general, than those of 
inorganic inanimate bodies. 

Without entering into an enumeration of all the distinctions,- 
between inorganic bodies and animated beings,- it may be stated r 
that inorganic bodies are homogeneous in structure, and would 
remain forever at rest, and unchanged, physically and chemi- 
cally, unless acted upon by extraneous forces ; whilst, on the 
other band,, all vegetables from the simple cell, to the most highly 
developed, and all animals from the simple cell animalcule, to 
the complicated organism of man, have arisen from cells, and 
are composed of cells, variously developed, and grouped so as 
to form organs, and systems of organs, and apparatus, capable 
of accomplishing definite results, when moved by the proper 
chemical and physical forces. 

The acts of development, nutrition, secretion, excretion and 
propagation are peculiar to plants and animals, and are directed 
by the vital force which is incorporated with, and presides over r 
every molecule of living organized matter, directing all its 
physical and chemical changes, so that amidst innumerable and 
unceasing changes the individuality of every organ, apparatus 
and animal is preserved. Physical and chemical forces exist 
independently of the vital force. The vital force, on the con- 
trary, cannot exist and manifest its peculiar effects, without 
matter and the physical and chemical forces. 

The germination and development of vegetables and animals 1 and 
the maintenance of their life actions, depend essentially upon the 
correlation of the vital, chemical and physical forces. 

The study of complicated, highly developed plants, and animals, 
involves the consideration of their origin, development, structure, 
and relations to exterior bodies — involves the consideration of the 
chemical and physical properties of the elements, and combination 
of elements, entering into their constitution, and the relations of the 
constituents of their bodies to the surrounding medium — involves 



1858.] JONES, on Malarial Fever. 365 

the consideration of the relations of the vital, chemical and physical 
forces and intellectual and moral faculties — involves the considera- 
tion of die relations of animated bodies to the forces of the sun. 

These phenomena may be studied with a greater degree of 
precision in the lowest orders of plants and animals, whose 
structures are simple. 

As we rise in the scale of vegetable and animal existence the phe- 
nomena of life become more complex and less general, and the 
conditions of existence become more complicated and restricted. The 
truth of this proposition is illustrated in a forcible manner, by 
the relation of vegetable and animal existence, to the distribu- 
tion of the forces of the sun upon the surface of our globe. 

Thus, as a general rule, after the inorganic elements and 
moisture have been supplied, the luxuriance and perfection of 
plants depend upon the intensity of the forces of the sun. The 
more complicated and perfect the vegetable structures, the closer is 
their dependence upon the proper supply and balance of the physical 
forces. The converse of this proposition is also true. 

The truth of this proposition is established by a reference to 
the distribution of plants upon the surface of our globe, and upon 
mountains which rise to a great height in tropical countries. 

Whilst, in equinoctial and tropical countries, where a suffi- 
cient supply of moisture combines with the influence of heat and 
light, vegetation appears in all its magnitude and glory ; on the 
other hand, in polar regions and upon the summits of lofty 
mountains, all the more complicated forms of vegetable existence 
disappear, and lichens and microscopic plants take the place of 
the majestic forests and impenetrable jungle. 

In the tropics, the lowest orders of plants are comparatively 
rare, whilst in the polar regions and upon the summits of moun- 
tains they form almost the entire vegetation. The plants which 
first form upon barren rocks and lava streams, and coral islands, 
are those of the most simple organization. The simply organ- 
ized lichens covering the bald-granite rocks are familiar to every 
resident of a primitive region. 

Along the sides of Etna, Ischia, Vesuvius, and other volca- 
noes, lava streams are seen stretching in all directions, which have 
flowed down like rivers. These lava streams are of different 
agea, and many of them were formed within the memory of 



366 Jones, on Malarial Fever. [June, 

man. An investigation of these lava streams affords an oppor- 
tunity of determining the gradual distribution of vegetables. 
Some are still naked — others have only a few plants, scattered 
here and there, in hollows and crevices, and in others the de- 
caying plants are forming a soil. 

According to the observations of Professor J. F. Schouw,^) 
•the plants which first settle upon the naked lava, and form a 
soil for the more complex, are especially those lower and simply 
organized plants called lichens. Certain succulent and fleshy 
plants, as the Indian fig (Opuntia vulgaris), which are nourished 
chiefly by the carbonic acid and aqueous vapor of the air ab- 
sorbed by the stem and leaves, are also amongst the earliest 
inhabitants of the lava streams. Geology also teaches that the 
lower orders of plants appeared first upon our globe. 

As the luxuriance and perfection of plants depend upon the tem- 
perature of the surrounding medium and the intensity of the forces 
of the sun, so also the perfection of the nervous system ; and of all the 
organs and apparatus, and the activity and intelligence of animals, 
correspond, in a great measure, to the rapidity of the physical and 
chemical changes going on in the molecules of their bodies, and to the 
relations of the physical and chemical and vital forces, and to the 
temperature which they are able to maintain, regardless of that of the 
surrounding medium. 

As the chemical changes become feeble, and the temperature of 
animals descends and becomes dependent upon, that of the surround- 
ing medium, they become more simple in their organization and mode 
of life, the conditions of their existence become less restricted, and they 
resemble closely the simple forms of vegetables, and in the twilight of 
existence, zve can scarcely distinguish between the lowest forms of 
plants and animals. 

If we examine the relations of the physical and chemical 
agents to the animal kingdom, we will find that the most sim- 
ply constructed animals, many of which are devoid of a nervous 
system and special organs of sense, as the infusoria, are, as in the 
case of the simply organized plants, the most widely distributed 
over the face of our globe, and are at the same time far less 
dependent for their existence upon the temperature of the sur- 
rounding medium. 

(1) Schouw's Earth Plants and Man. — Bohn's Scientific Library. 



1858.] Jones, on Malarial Fever. 367 

Infusoria occur in immense numbers in every situation : in 
stagnant pools, in marshes, in mud of rivers, in peat earth, 
twenty feet below the surface ; in the structures and fluids of 
living animals and vegetables, in putrifying organic matter, in 
the bed and waters of the ocean, in snow, in ice, and in boiling 
springs. Sir John Eoss, in the year 1840, picked up some 
brash ice, of a brown yellow color, in the Arctic regions, not 
far from Mount Erebus, which was supposed to contain allu- 
minous matter, ejected in fine ashes from the volcano. Speci- 
mens were brought home in sealed glass vessels, and forwarded 
to M. Ehrenberg. This microscopist found the coloring matter 
to consist of myriads of infusoria, almost the whole of which 
reachad Berlin in 1844, in a living state. 

Here we see that these microscopical animals, after having 
been frozen and thawed out, lived without food for four years. 

Certain species of these animalcules have been found living 
and propagating in boiling springs, and some of them have been 
observed to recover, after drying in vacuo along with chloride 
of calcium and sulphuric acid for twenty -eight days, and after 
exposure to a heat of 248°. (2) 

The infusorial animals were created at an early geologic 
period, and a large number of the fossil species which compose 
the Polirschiefer and semi-opal of Bilin, are found at the pre- 
sent time living and propagating in the seas and oceans. The 
infusoria form a chain connecting (he organic life of distant ages of 
the earth, and demonstrating, conclusively that the distribution of 
animals, and the power to survive physical changes, depends upon 
their development. 

The simpler the structures, the feebler the vital, nervous and 
physical forces, the less complicated the conditions of existence. 

The gelatinous medusas (Gelly fishes) occur in such vast num- 
bers in the cold Greenland sea, that they impart an olive-green 
color to the sea, rendering the water dark and opaque in com- 
parison with the ordinary cerulean hue. 

(2) See experiments of Doyere, in Mem sur les Tardigrades, et sur leur propriete 
derevenir a'la vie, 1842, pp. 119, 129, 131, 133. Also, Ehrenberg's Die lufuSions- 
thierchen, als vollkomme Organismem, 1838. 

(3) See Remarks on the real occurrence of Fossil Infusoria, and their extensive 
diffusion, by Prof. Ehrenberg, J. C. Poggendorffs Annalen der Physik and Chimie, 
vol. xxxviii., No. 5. Taylor's Scientific Memoirs, vol. 1, 1837, pp. 400 to 413 ; 
also, vol. 3, 1843, pp. 219-376. 



868 Jones, on Malarial Fever. [June, 

The space- allotted to this article will not allow us to enter 
more fully into the consideration of the distribution and relation 
to the physical forces, of the other members of the invertebrate 
kingdom. 

These facts are sufficient to illustrate for this class of animals, 
this law, which has an immediate bearing upon our investiga- 
tions. 

Cold-blooded vertebrate animals, although more highly or- 
ganised than invertebrate animals, still show remarkable pow- 
ers of enduring extremes of heat and cold, without death. Fish 
may be frozen and again thawed out without a destruction of 
life. The rapidity with ivhich the absence of heat is attended with 
loss of sensibility and death, is directly proportional to the develop- 
ment and perfection of vertebrate animals. 

The relations, between the physical, chemical and vital forces, 
are strikingly exhibited in certain cold and warm-blooded ver- 
tebrated animals, which become torpid or hybernate during 
the winter season. In this state, all the chemical and physical 
actions are of the most sluggish character. The heart scarcely 
beats, the frequency and force of the action of the heart, and 
flow of the circulation, is greatly diminished, if not entirely 
stopped. The amount of carbonic acid thrown off from the lungs 
is greatly diminished, and all the chemical and physical changes 
of the elements of the tissues, and fluids and organs of these an- 
imals, are retarded. 

If the temperature of a warm-blooded animal be reduced in 
like manner, all its physical, chemical, and vital actions will be 
depressed, and the active animal will be reduced to the condi- 
tion of a sluggish cold-blooded animal, and death will rapidly 
ensue. There is, however, this great difference between the 
cold and warm-blooded animal — the conditions of the existence of 
the latter are far more restricted than those of the former. 

The chemical changes of the cold-blooded animal are slow, 
and it can exist without food for weeks and months, whilst a 
few days starvation is fatal to the warm-blooded animal. 

These facts demonstrate conclusively that the conditions and phe- 
nomena of life are complicated and restricted, in exact accordance 
with the development and perfection of the organs and tissues of an- 
imals, and the rapidity of the chemical and physical changes of the 
molecules of their bodies, 



1858.] Jones, on Malarial Fever. 369 

To understand the bearing, complication and imperfections of pa- 
thological investigations, ice must take a general view of the most 
important phenomena and relations of man. Those who would at- 
tempt to investigate pathological and physiological phenomena, must 
first form clear concepAions of the phenomena to he investigated, and 
the perfection of the methods and instruments capable of being em- 
ployed in these investigations. 

Man is composed of inorganic elements, prepared and grouped 
into definite compounds in the vegetable kingdom, by the com- 
bined actions of the vital force, and the physical and chemical 
forces of the sun. 

Man is governed by all the laws and phenomena of inorganic 
bodies, and is absolutely dependent for his existence upon the 
existence and mutual relations of inorganic bodies. 

As all the motions, in the various forms of inorganic matter upon 
the surface of our globe, are excited by the forces of the sun, in like 
manner, all the forces of man, are dependent through vegetables, upon 
the forces of the sun. As there can be no creation of force in inor- 
ganic matter, independent of the Deity, so man, although an active 
being, cannot create any force, however feeble, any more than he can 
create or annihilate a particle of matter. His forces are the result- 
ants of the chemical changes of those substances, which, in the veget- 
able kingdom, have been elevated into a state of force by the action of 
the sun. 

The mechanical power which man, or any animal, is able to 
exercise, is exactly proportional to the amount of food consum- 
ed, assimilated and chemically altered in the production of the 
nervous and muscular forces. The power of a well-constructed 
steam-engine, is exactly proportional to the amount of fuel con- 
sumed, or, in other words, is exactly proportional to the amount 
of chemical action. The amount of chemical action is exactly pro- 
portional to the amount of force derived from the sun, and expended 
in grouping the molecules of matter, in such a manner, as to be capa- 
ble of chemical change and development of physical force. The 
power of falling water which turns the water-wheel, and accom- 
plishes various mechanical operations, is the resultant of the 
combined actions of gravity, and the heat of the sun. The laws 
of physics apply as well to the human machine in action, as to the 
changes in Oie exterior universe. 



370 Jones, on Malarial Fever. [June, 

Man is the most perfect engine that has ever been constructed 
for the same amount of chemical combinations and decomposi- 
tions, he produces a much greater amount of work than the 
most perfect engine. 

Man has other phenomena besides the physical and chemical. 
He is a machine and something more. The generation, devel- 
opment, constitution, and structure of man is similar to that of 
all vegetables and animals. 

Man, in common with vegetables and animals, is endowed 
with vital force, and like them is dependent for his existence 
and action upon exterior bodies, and the physical and chemical 
forces. 

Man, in common with all animals, and in contra-distinction 
to vegetables, possesses a nervous system, endowed with special 
sensibilities. 

The nervous system is the apparatus which relates man and 
animals to the exterior world, and also relates the various or- 
gans and apparatus to each other, in such a manner, that amidst 
an innumerable number of complex actions, unity and harmony 
result. 

Man possesses not only a vital force, an organism composed of inor- 
ganic elements, perfect in its mechanical structure, and material arrange- 
ments of its parts, and a nervous system endowed with special sensibili- 
ties ; but he also possesses an intelligence endowed with special faculties, 
capable of receiving impressions from the motions of exterior bodies, and 
of exciting the forces by which it is surrounded, and a moral nature 
which relates him in a peculiar manner to the universe. 

The possession of moral and intellectual faculties combined, 
distinguishes man from every other form of matter, and every 
other being upon our globe. 

The immaterial, intellectual, moral soul of man has no direct 
communication with the exterior world. The mind receives 
impressions, transmits its volitions, and excites the mechanical 
structures of the engine by which it is environed, through the 
nervous system which is endowed with special sensibility. The 
impressions of exterior bodies, upon the nervous system, is always 
attended by a change of the structure of the nervous system. 

All the organs of sense are excited by changes of matter. 
The excitement of the nervous system and transmission of the 



1858.] Jones, on Malarial Fever. 371 

impressions are attended by a change of matter. Every act of 
the mind which excites the nervous sytem, is attended by a 
change of the chemical elements of the nervous system. Every 
action excited in the mechanical apparatus by the nervous system 
is commenced and sustained by a physical and chemical change 
of the elements of the muscular system, and nutritive fluids. 
The intellectual and moral faculties of man work only through and by the 
physical and chemical forces ; they are distinct from matter, they excite 
matter to action, they direct and control the actions of matter. 

By his intellectual moral nature, man overcomes all the barriers and 
obstacles of nature, not by a suspension or alteration of her immutable 
laws, but by peculiar applications of those forces and laws. 

The material portion of man is composed of the same elements as the ex- 
terior world. It is governed by all the astronomical and chemical and phys- 
ical laws of inorganic bodies, and comprehends within itself all organic 
nature. The size of his organs, the strength of his muscles and 
bones, and the vigor of his forces, have all been constructed 
with exact reference to the force of gravity, the size of our 
globe, and its relations with the sun, and all other worlds in the 
universe. Man revolves with the earth and planets around the 
sun, and the whole system moves forward in space at the annu- 
al rate of one hundred and fifty millions of miles, around a dis- 
tant unknown centre. Like plants and animals, his existence 
is dependent upon the length of the day, and of the year, which 
are dependent upon the adjustments of the solar system. His 
existence, through plants, is absolutely dependent upon the 
intensity of the forces of the sun. If the distance from the 
earth to the sun be increased or diminished, the structure of 
many inorganic bodies w^ould be changed, the conditions of. ex- 
istence would be correspondingly altered, and all vegetable and 
animal life would be destroyed. 

The molecules composing the structures of man, like the im- 
mense masses of matter which are scattered through space, are 
in a state of unceasing activity. As each star has its own ap- 
propriate motions, its own peculiar offices to perform, so each 
molecule of matter, each organ and tissue in the body of man, 
has its own peculiar motion, its appropriate office to perform. 

A$ the universe is governed by a Being, infinite in wisdom 
and in power, who constructed, controls and directs matter and 



372 Jones, on Malarial Fever. [June, 

all its chemical and physical actions, so the material part of man, 
this little world, is governed by an intelligence distinct from 
matter, which works by and through matter, and moulds exte- 
rior material nature, after the ideal creations of its own interior 
immaterial nature. Man then is a type of the universe. It is evident, 
therefore, that to understand the phenomena of man in health and disease, 
and his relations to the universe, we must comprehend the phenomena and 
mutual relations of all animate and inanimate bodies, terrestrial and 
celestial 

If the phenomena of man in health be thus complicated, how 
much more complicated must they be in disease, where the com- 
plex constitution of his solids and fluids may be altered in many 
ways, and the relations between the vital, chemical and physical 
forces deranged. 

Any one of the normal constituents of his body may be deranged, 
and occupy different relations to each one of the other constituents. 
As these constituents are numerous, the resulting derangements 
may be correspondingly numerous. The forms of this class of 
diseases may be as numerous as the different positions which the 
elements may be made to assume towards each other. 

Any one of the elements of his body may be in excess or deficiency, and 
the diseases may be as numerous as the elements themselves, and at the 
same time totally different from the diseases arising from an alteration in 
the relative positions of the elements. 

Foreign morbific agents may be introduced into the fluids and solids, 
which will excite abnormal changes in the elements of the solids and fluids. 
The number of diseases of this class will correspond to the num- 
ber of distinct morbific agents. Combinations of these morbific agents 
may produce still more numerous and complicated diseases. 

The Creator has associated the vital force with a definite constitution of 
matter. Whatever interferes with this constitution, interferes with the 
action of the vital force. Whatever interferes with the vital force, neces- 
sarily disturbs its relations with the physical and chemical forces. If 
the balance of the forces, their correlation be disturbed, the chemical ac- 
tions between the elements may not only be deranged in kind, but also in 
degree, and the generation of the physical forces which work the machine- 
ry, and the manifestation of the intellectual and moral phenomena will 
be correspondingly altered. 

One or two, or all of these causes of disease may act atpnce, 
or successively, and thus render the results still more complex. 



1858.] JoXES, on Malarial Fever. 373 

The relative intensity of the effects of disease will depend upon the 
perfection of the constitution and relations of the organs, tissues and ap- 
paratus, and upon the power and correlation of the vital, chemical and 
physical forces. As no two human countenances are exactly 
alike, as no two temperaments are exactly alike, as the chemical 
actions and forces of different individuals vary, so also will the 
effects of disease vary. 

The nervous system is the last and most perfect work of the 
vital force, and thus the index of the power of the vital force. 

The nervous system not only forms the medium of communi- 
cation between the intellectual faculties and the exterior world, 
but it also forms the medium of communication between the 
organs and apparatus, solids and fluids of the economy. That 
the nervous force is nothing more than a higher development of 
the vital force, is evident, from the fact that plants, and the sim- 
ply constructed animals, which are devoid of a nervous system, 
are capable of carrying on the offices of generation, develop- 
ment, digestion, assimilation, nutrition, secretion, excretion, and 
preserving a definite form amidst unceasing changes. Many of 
the simply organised animals, although without a nervous sys- 
tem, still possess sensation and voluntary motion. The nervous 
system appears only when the parts of the machinery are com- 
plicated, and need a special means of communication. 

The development and perfection of the nervous system cor- 
responds exactly to the development, perfection and complica- 
tion of the organs and apparatus. 

This fact is true of the animal kingdom in its successive 
degrees of development, and also of the successive stages of the 
development of the solids and fluids of each individual highly 
organized animal. Physical and chemical actions take place in 
a similar manner in all animals, simple or complex ; they differ 
only in intensity. The higher the animal, the more complicated 
its parts, the more rapid the chemical changes and consequent 
generation of the forces, and the greater is the necessity for some 
special apparatus endowed with a high vitality, which will bring 
all these complex organs and actions into relation. Unless the 
actions of different organs can be telegraphed (so to speak) to 
each other, confusion in a complicated organism will necessarily 
result. Thus, if the amount of blood circulating through any 



374 Jones, on Malarial Fever. [June, 

organ, and the chemical actions, are too great, how can they be 
regulated without some medium of communication with the 
other parts of the system, and some means of regulating the 
chemical and physical actions ? To the nervous system is dele- 
gated this property of regulating the actions of the organs and 
apparatus, and thus regulating the amount of oxygen and blood 
supplied to the organs and tissues and apparatus. 

The blood supplying the nutritive elements of the tissues 
and organs, and the materials for the secretions and develop- 
ment of the forces, and oxygen being the active agent in all 
the chemical actions of the bodies, it is evident that whatever 
disturbs the constitution of the nervous system, necessarily 
disturbs the functions of the apparatus and organs and pro- 
duces corresponding alterations in their secretions and excre- 
tions. As the integrity of the nervous system depends upon 
the integrity of the blood, in like manner, whatever alters 
the constitution of that fluid, will produce aberrated action in 
the nervous system, and in turn, this disturbance may extend 
itself indefinitely. 

Disease then, whether arising in the organs, or in the blood, or origin- 
ally in the nervous system, will always be attended by aberrated nervous 
action. The most prominent symptoms of disease therefore will be con- 
nected with the nervous system. In all our investigations into the 
causes and effects of disease, we should always remember, that the origin 
of the disease may be connected with derangements in the constituents of 
the blood and all the organs, independent altogether of the nervous system. 
Thus in malarial fever, the poison, whatever it be, is rapidly 
destructive of the colored blood corpuscles, and destroys the 
ferment in the blood, which converts the animal starch into 
grape sugar, it also produces profound alterations in the struc- 
ture of the spleen and the blood which it contains. Now, 
these effects, in the beginning, may take place entirely indepen- 
dent of any alteration in the nervous system. 

The nervous system will be secondarily affected, and its ac- 
tion seriously disturbed, and this disturbance will give rise to 
a distinct set of phenomena, but it is evident that the cause and 
origin of the disease lies back of this disturbance. 

In the investigation of the origin, causes, effects and treatment of 
disease, the constitution of all the fluids and solids of all the organs and 



1858.] Jones, on Malarial Fever. 375 

tissues, of the blood, secretions and excretions, should be carefully as- 
certained and compared with the standard of health. All the chemical 
and physical changes, and the relations of the vital and physical forces, 
should be ascertained. 

The temperature, the amount of chemical change, the alterations in 
every organ and tissue should be determined How can these 
things be accomplished when physiologists and pathologists 
are not acquainted with many chemical changes going on in 
the body : — when they dispute about the origin and offices of 
some of the most important constituents ; and know little about 
the origin and offices of the extractive matters of the blood and 
urine: when they are ignorant of the offices of the spleen, 
supra-renal capsules, tlrymus and thyroid glands : when they 
cannot even explain the mode of origin, propagation and death 
of the solitary gland cells of the blood, which elaborate the 
materials for the nervous and muscular systems : when they 
possess no absolutely accurate method of analyzing the blood, 
or of determining the amount of the products thrown off from 
the lungs and skin ? It is important that we should know and 
acknowledge our ignorance and weakness. 

At the very outstep, I acknowledge that these physiological 
and pathological investigations, which I hope to present from time 
to time, are imperfect in many respects. They could not be 
otherwise in the present state of science, and especially when 
I had to act as physician and surgeon to one hundred patients, 
and at the same time, conduct the investigations. 

I have determined to present them in their imperfect con- 
dition, because they were instiuted with a desire to discover 
the truth, and with the hope that I might acquire during their 
prosecution, sufficient knowledge to point out to the young mem- 
bers of the profession, the difficulties and methods of conducting 
such investigations ; and because they were conducted at a sacri- 
fice of much time, money, and health. 

" Art is long and time is fleeting, 

And our heaits though stout and brave, 

Still like muffled drums are beating 
Funeral marches to the grave." 

/ think and hope that they will at least demonstrate the impossibility of 
the successful investigation, of all the phenomena of disease, by a single 
individual, and lead to unity and concert of action amongst investigators. 



376 Jones, on Malarial Fever. [June, 

In pathological investigations, we need in this country, above all things, 
an organised corps, who would make a division of labor. We should 
have a separate investigator for the careful examination of each 
one of the following subjects : 

The analysis of the urine (1); blood (2); determination of animal 
temperature (3) ; functions of skin and lungs (4); record of symptoms 
and treatment (5) ; meteorologic, geologic* and topographical investiga- 
tions, and record of mortuary statistics (6) ; examinations chemically and 
microscopically of the structure and alterations in the nervous system 
after death (7) ; and of the liver and bile (8) ; of the alimentary canal 
with its secretions and excretions (9); and of the kidneys and the other 
organs (10). _ 

If a corps of intelligent, generous-minded observers would act 
with zeal and unity, the results' for medicine would be of the 
most momentous character. It would, in time, rank amongst 
the exact sciences, and the physician would become a true pro- 
phet ; and instead of the frequent disagreement between theory 
and practice, and between rival schools, we would have harmo- 
ny; instead of distrust in the public, and even in the minds of 
physicians, themselves, we would have confidence. 

These investigations were conducted in the Savannah Marine 
Hospital and Poor-house, and two hundred and fifty patients 
suffering with the different forms of malarial fever, came under 
my observation. 

I would here acknowledge my obligations to my friend and 
former colleague, Dr. Eichard D. Arnold, Professor of the The- 
ory and Practice of Medicine in the Savannah Medical College, 
for his kindness in resigning into my hands, the charge of the 
Savannah Marine Hospital and Poor-house. 

I would also, return my thanks to Theodore McFarland, M. 
D., and Mr. Eobert Myers, student of medicine, in the Savan- 
nah Medical College, for valuable assistance during post-mor- 
tem examinations. 

The medical topography of Savannah will be considered more 
fully hereafter. The following brief statement will give a gen- 
eral idea of the medical topography. 

Savannah is situated on the Savannah river, eighteen miles 
from its mouth, upon a sandy plain, elevated forty-two feet 
above half tide. On the north, this plain is terminated abruptly 
by the Savannah river, a turbid stream, pursuing its sluggish 



1868.] Jones, on Malarial Fever. 577 

course through the low-grounds and rice-fields of South Carol i- 
na and Georgia. On the east and west, the city is flanked by 
extensive tide-swamps, formerly under wet culture, at the pre- 
sent time under dry culture. The sandy plain extends for sev- 
eral miles beyond the city. Savannah, therefore, is surrounded 
on all sides, except the south, by malarious districts. 

Section I. — Intermittent Fever. 

Case I. — Seaman, entered Savannah Marine Hospital Sep- 
tember 29th, 1857; native of New York; age 22; height 5 feet 
4 inches; weight 140 lbs. ; black hair, and florid complexion; 
handsome, intelligent countenance; sanguine nervous tempera- 
ment. Has never been sick before. Has been in Savannah 
two weeks, and this is his first visit. Slept on board the ship 
the first week, and the last week slept at the "Sailor's Home,"" 
on the bay. Says that he was taken sick four days ago, with 
chill, vomiting, and pains in all his bones, and has had a chill 
every day since., commencing regularly at 12 o'clock M. Had a 
chill this day, commencing a few minutes after 12 o'clock M. 
Says that he took three blue pills and castor oil, night before 
last. This medicine operated twice. 

7 o'clock P. M., Sept, 29th. Has fever, and complains of pains 
in his joints. Slight tenderness upon pressure of epigastrium ; 
tongue clean, moist, red at tip and edges; papillae enlarged and 
of a bright red color. Eeaction of saliva decidedly acid. 

Pulse 120. Respiration 32, full, thoracic. 

Temperature of Atmosphere, 79°F. 

11 Hand, 103°33' 

11 under Tongue, 106° 

$. Calomel, grs. xij.; sulphate of quinia, grs. vij. Mix, and 
administer immediately, and follow with castor oil in four hours. 
As soon as fever remits, give sulphate of quinia, grs. v., every 
three hours, up to grs. xxv. During fever, give soda powders 
(pulveres effervescents tartarizati). Diet, gruel and flaxseed tea. 

Sept. 30th, 1 o'clock P. M. Medicine operated freely, and 
says that he is much better, but complains of weakness. Tongue 
presents the same appearance; skin cool and relaxed; face not 
so much flushed. 

Pulse 70, regulafr. Respiration 22, regular and gentle. 

Temperature of Atmosphere , 68°F. 

" Hand, 92° 

" under Tongue, 99° 5' 

Amount of urine passed the last 18 hours, grains 23,220. 

Amount of urine excreted each hour, grains 1,290. 

Calculated amount of urine for 24 hours, grains 30,952. 

Reaction of urine decidedly acid. 



378 Jones, on Malarial Fever. [June, 

This is characteristic of the urine df fever ; the acidity is in pro- 
portion to the severity of the attack. The acidity is more intense in 
remittent than in intermittent fever, and still more intense in conges- 
tive fever, than in intermittent and remittent fever. 

Color of urine, light orange. Urine passed last evening and 
night up to 11 P. M., specific gravity 1011, color a shade higher 
than that passed this morning. Specific gravity of urine passed 
from 11 o'clock P. M., last night, up to 1 o'clock P. M., this dav, 
1008. 

Uric acid in whole amount of urine passed in 18 hour, (grs. 23,220). grs. 1-0035 
" " calculated " " " " " 24 " (grs. 30,952). " 1-3376 

Uric acid in 1000 parts of the night urine, (sp. gr. 1,011) 0-0494 
" " " " " " morning " (sp. gr. 1,008) 0*0396 

Up to this time, 1 o'clock P. M., has taken 20 grains of sulph- 
ate of quinia, and the action of this medicine may be connected 
with the marked diminution of the uric acid. 

The urine was set aside and examined under the microscope 
after successive intervals. After standing 48 hours, there was a 
small light yellow deposit, which, under the microscope, was 
found to consist of small vegetable cells of several shapes — glo- 
bular, elliptical, and acicular. When viewed under a low mag- 
nifying power, these cells resembled a collection of globular and 
acicular cystals of the urates of ammonia. 

A careful examination under the microscope, with the appro- 
priate chemical re-agents, demonstrated that they contained no 
uric acid or inorganic salts, but were of vegetable origin. The 
size of the cells were many times less than those of the torula 
cerevisiae. 

5 o'clock P. M. Half an hour ago was taken with chill and 
vomiting. Now the chill appears to be subsiding, the shaking 
and contraction of the muscles is diminishing. Extremities cool, 
whilst the head and trunk are hot and pungent to the hand. 

Pulse 108. Kespiration 30, labored, thoracic. 

Temperature of Atmosphere, 74° F. 

11 Hand, 91° 

" under Tongue, 105°5' 

Instead of a reduction of temperature in the trunk and head dur- 
ing chill, there is a decided elevation. The sense of cold arises from 
a want of circulation in the capillaries of the extremities. 

The patient had taken 20 grains of the sulphate of quinia be- 
fore the chill came on. This did not arrest, but delayed the chill 
for several hours. 

3. Spirits of Mindererus f I iss. in sweetened water. 

8i o'clock P. M. Says that he is more comfortable. 

Pulse 108. Eespiration 32, not so thoracic and labored as 
during the chill, but still thoracic and labored. 



1858.] Joxes ; on Malarial Fever. 379 

Temperature of Atmosphere, 73°F. 

" Hand, 103.5° 

11 under Tongue, 105° 

Slight tenderness upon pressure of epigastrium. Eeaction of 
saliva decidedly acid. Tongue red at tip and edges; papillae 
enlarged and red. 

Amount of urine passed from 1 P.M., (8 hours), grs. 5,100. 
Calculated amount for 2-i hours, grs. 15,300. 
Amount of uric acid in 5,100 grs. of urine, grs. 2. 
" ii ii a u 15^00 « « « " 6. 

Uric acid in 1000 parts of urine, 0-3921. 

Specific gravity of this specimen of urine excreted during the 
chill, 1020. Color normal. Reaction decidedly acid. 

The uric acid has increased in amount during the chill and 
commencement of the fever : when compared with the former 
specimens of urine, it is, however, still below the standard of 
health. If the diminution of the amount of uric acid be due to 
the action of the sulphate of quinia, it shows that this action of 
this remedy pointed out by Ranke, 3 is not necessarily attended 
with a disappearance of the chill. 

Amount of urine excreted hourly during last 24 hours, grains 
1,180. 

Amount of urine passed in the last 24 hours, ending Sept. 
30th, 8 o'clock P. M.. grs. 28,320. 

Amount of uric acid in grs. 28,320 of urine, grs. 3.0035. 

$. As soon as fever remits, give sulphate of quinia, grs. v., 
every three hours, up to grs. xx. Diet, gruel. 

October 1st, 11 o'clock A. M. Says that he is better, and has 
no pain, except a slight headache, and was in a perspiration all 
night. Fever intermitted at 12 P. M. 

Skin cool. Pulse 76. Respiration 23. 

Temperature of Atmosphere, 70° F. 

" i " Hand, 95° 

" under Tongue, 98°5' 

Has taken 15 grs. of sulphate of quinia since the intermission 
of the fever. 

$ . Continue sulphate of quinia up to grains xxv. 

Diet, mutton soup, gruel and tea. 

Reaction of saliva slightly acid. Reaction of urine decidedly 
acid. Urine clear, no deposit, and a shade higher colored than 
normal. 

Specific gravity of the urine passed during the first half of the 
night, 1010. 

Specific gravity of the urine passed subsequent to 12 M., last 
night, 1012. 

■ - — ■ . —• — » . — i* 

(3) Medical Times and Gazette, May 30, 1857, p. 54a 
n.b. — vol. xrv. no. vi. 17 



380 Jones, on Malarial Fever. [June, 

Amount of urine passed during the last 15 hours, grs. 19,209. 

Calculated amount of urine for 24 hours, grs. 30,734. 

Amount of urine excreted each hour, grs. 1280. 

October 2nd, 11 o'clock, A.M. — Says that he feels badly ; had 
no chill yesterday evening, but the fever came on at 7 o'clock, 
P. M. Suffered with headache, and was restless, without sleep 
during the night. Skin soft and moist ; slight tenderness upon 
pressure of epigastrium; tongue redder and dryer than yester- 
day, but still soft and moist ; reaction of saliva, acid ; face flushed. 

Pulse 84. Respiration 32. 

Temperature of Atmosphere, 74° R 

" Hand, 100. 5' 

" under Tongue, 102 

The fever is subsiding. Urine of a deep orange color : higher 
colored than yesterday ; turbid, with slight deposit. Reaction, 
alkaline, after standing 20 hours; it was acid when first voided. 
The deposit is due to the precipitation of the alkaline and 
earthy phosphates, in combination with the ammonia, generated 
during the decomposition of the urea. 

As far as my experience extends, the rapid change from the acid to al- 
kaline reaction of the urine is, in malarial fever, a sign of convalescence. 

Every specimen of urine excreted during the active stages of malarial 
fever, which I havd examined, gave a decided acid reaction, and the in- 
tensity of this reaction corresponded to the intensity of the disease. As 
the disease declined, the reaction of the urine oecame less acid, and the 
tendency to fermentation, and the development of an alkaline reaction 
increased. 

Amount of urine passed during the last 24 hours, grs. 15,810. 
" of uric acid in 15,810 grs. of urine, grs. 9.300. 

Specific gravity, 1020. 

Uric acid in 1000 parts of urine, 0.588. 

Amount of urine excreted hourly, grs. 658. 

Has not had a movement of his bowels since the operation of 
the calomel. 

^ Calomel grs. vi; sulphate of quinia grs. vi; castor oil in 
four hours. After the action of the calomel, commence with 
sulphate of quinia, grs. v, every three hours up to grs. xv. 

October 3rd, 11 o'clock, A.M. — Says that he feels much better, 
and has " no pain, except a slight soreness in his bones." Tongue 
clean, moist, and only a shade redder than normal. Papillae 
still enlarged, red and distinct. Reaction of saliva, acid. No 
pain upon pressure of epigastrium. The fever intermitted yes- 
terday afternoon, and he has had no return. 

Pulse 62. Respiration 20. 

Temperature of Atmosphere, 74° F. 

" Hand, 96° 

" under Tongue, 98°5' 



1858.] JOXES, on Malarial Fever. 381 

Color of -urine a shade lighter than normal, and in 22 hours 
after it was voided, let fall a copious light yellow deposit of tri- 
ple phosphate and urate of soda. 20 hours after it was voided, 
its reaction was decidedly alkaline. It was acid when first 
voided, but much less acid than during fever. The urea has 
also undergone decomposition much more rapidly, because it 
has become decidedly alkaline in the same time in which the fe- 
brile urine remained decidedly acid. When first passed, the 
urine was clear, devoid of sediment. The deposit in the urine 
which had stood over night, was due in a great measure to the 
precipitation of the phosphates, by their union with the ammo- 
nia generated during the decomposition of the urea. 

Amount of urine passed during the last 24 hours, grs. 18,180. 
Specific gravity 1010. 

Amount of urine excreted hourly, grs. 757*5. 

Uric acid in grs. 18,180, of urine, grs. 8*100. Uric acid in 
1000 parts of urine, 0"445. 

$. Officinal infusion of Virginia snake-root, fixviii. ; sulph. 
of quinia, grs. xv. Mix. Tablespoonful every three hours. 
Diet, mutton soup and boiled rice. 

October 4th, 11 o'clock A. M. Much better. Has had no 
return of chill and fever. Tongue clean and papillae not so dis- 
tinct and red. Bowels opened twice. 

Pulse 60. Respiration 20. 

Temperature of Atmosphere, 72°5'F. 

" Hand, 96° 

" under Tongue, 99°5' 

Reaction of urine after 18 hours strongly alkaline. It emits 
ammonia. "When a rod dipped in hydrochloric acid is held over 
the urine, it emits heavy fumes of hydrochlorate of ammonia. 
Heavy light yellow deposit. 

Amount of urine passed during the last 24 hours, grs. 20,520. 
" " " " hourly, grs. 855. 

Specific gravity, 1018. 

R. Officinal infusion of quassia and soda. Continue snake- 
root tea. 

October 5th, 11 o'clock A. M. Has had no return of fever, 
and complains of nothing except weakness. Tongue clean, 
moist and soft; papillae still redder and more enlarged than 
normal ; skin soft and cool ; reaction of saliva acid. 

Pulse 62. Respiration 21. 

Temperature of Atmosphere, 70 D F. 

" Hand, 96° 

" under Tongue, 99°33' 

Urine normal in color. Specific gravity 1015. Amount of 
urine excreted hourly, grs. 1268. 



3S2 Joxes, on Malarial Fiver. [June, 



Amount of urine passed in last 24 hours, grs. 30,450. 
" " Uric acid in grs. 30,450 of urine, grs. 15,000. 

Uric acid in 1000 parts of urine, 0*492. 

After standing 12 hours, alkaline reaction and a light yellow 
deposit. 

This patient continued to improve, and left the hospital on the 
following day. He returned to the same locality on the bay, 
and was exposed to the damp north-east winds blowing over 
the river and low grounds of South Carolina. 

He returned to the hospital October 18th, with an attack of 
chill and fever, of the same type as the one we have just describ- 
ed. The chill came on every day. 

The annexed Table will present a condensed view of the phe- 
nomena observed. 

In this case there was a close relation between the state of the skin, 
pulse, respiration and temperature of extremities and trunk. 

A rapid full pulse, hurried thoracic respiration, and dry shin, 
was attended with a corresponding elevation of temperature. 

If the functions of the organs and apparatus be properly per- 
formed, a full and rapid vigorous circulation and respiration 
must be attended by the rapid absorption of oxygen, and exha- 
lation of carbonic acid gas, and correspondingly rapid chemical 
changes, and development of heat. 

A slow pulse and respiration, and cool moist shin, was accompa- 
nied with a lovj degree of heat. 

During the cold stage (chill) there was a rapid feeble pulse, full 
thoracic rapid respiration, and a hot trunk and cold extremities. 

During the rapid thoracic respiration, oxygen is supplied in 
abundance, and enters into the blood, which is confined during 
the cold stage, almost entirely to the trunk and large organs. 
The temperature of the trunk is correspondingly elevated. This 
elevation of temperature does not extend to the extremities, be- 
cause the circulation of the blood in the blood-vessels and capil- 
laries is feeble. The surface of the extremities look bluish dur- 
ing the cold stage, because the supply of oxygen being withheld 
in great measure, the change from the venous to arterial hue 
does not take place. 

We hope to demonstrate hereafter, by numerous careful ob- 
servations, that the determination of the relations of the circula- 
tion, respiration, and temperature or chemical changes in mala- 
rial fever, is of the greatest importance, in enabling the practi- 
tioner of medicine to understand the nature and treatment of the 
different forms of this disease, and predict with a great degree of 
certainty its course and termination. Whenever, as in congestive 
fever, there is a want of corresponaence between the circulation, respi- 
ration and chemical changes, the patient is alvjays in danger. A 
patient with a rapid feeble pulse, and rapid thoracic respiration and 



1858.] 



Joxes, on Malarial Fever. 



383 



Calculated amount of Uric 
Acid excreted in 24 hrs. 



Calculated amount of Urine 
excreted in 24 Lours. 



Uric Acid. 



§ 



Specific Gravity. 



o -< 

<N .-I 
O O 



O oc o 

© o © 



Hours. 



C-i 



Urine excreted in 



o 5 
o o 

1-1 (M 



o o o 

00 cn o 

00 o o 

i-i iM CO 



Urine excreted hourly. 



XT- IC 00 
VQ U5 SO 
X> 00 <N 



Uric Acid excreted in 24 
hours. 



o • o 
o • o 
,-i . o 



CO 

< 



Urine excreted in 24 hours, grains. 



o cs 
CM o 

CO CO 



oo 

CM O 

© o 

CM CO 



Temperature under Tongue. 



o o o o 

OS iO 1O00 
O O O OS 



»o >o CO 
o o o 

oo oo 



Temperature of Hand. 



c ■ 
o o o o 

CN .-I C3 »0 

© Cft o o> 



o o 

SO SO 
OB C5 



Temperature of Atmosphere. , 



o o o o 
x — :t C 



W3 

o o o 

■«* <M O 



Respiration 






Pulse. 









2 S'O 

-5 a a s-s-s-i 



If* 



esi 



c3 cJ 

g g 

O O 




a 



■5 £ .-5 
S--H >jt 

« «* £ ' '~ bC ^ 
60 W>- 5.2 ^ 

ja £3 g^ 

= - '>-= £"3 
f2\S*o boaa an "c 



O 



Hour of Day. 



00 .-H i-i 






Day of Month. 



Month . 



384 Jones, on Malarial Fever. [June, 

low temperature {sluggish chemical- changes), is always in great 
danger. A full rapid pulse, and rapid thoracic respiration, and 
correspondingly high temperature, are always favorable symptoms, 
provided there be no complication, as congestion of the brain. The 
severity of malarial fever is by no means proportional to the height ' 
of the fever {animal temperature). Asa general rule, the higher the 
fever {temperature), the more readily does the attach yield to treat- 
ment, and the less serious the effects. High temperature signifies 
active chemical changes, and an effort on the part of nature to break 
up and consume the poison, and a power of resistance. 

It is the want of a high temperature which is the most dangerous 
symptom in malarial fever. 

In this case, the amount of urine excreted corresponded with 
its specific gravity, or degree of concentration. Considering the 
situation and diet of the patient, the amount of urine did not 
differ greatly from the standard of health. 

The urine is affected by so many varied external and internal 
conditions, that the amount excreted exhibits great fluctuations 
even in health. 

No two observers agree with reference to the amount excreted 
in definite periods. Thus, Lecanu, from examinations of the 
urine of 16 individuals, living upon mixed food, estimated that 
the amount of urine discharged in 24 hours, ranged from 8085 
grains to 84,973 grains. 

Becquerel found that the mean daily quantity passed by four 
men, was 19,511 grains, and that by four women, was 21,130 
grains. 

Lehmann, from experiments instituted upon himself, estimat- 
ed the quantity discharged daily, at from 18,829 grains to 22,299 
grains. 

According to the valuable experiments of Dr. William A. 
Hammond, instituted upon himself, the amount of urine excreted 
under a mixed diet, ranged from 19,684 grains to 22,756 grains, 
with a mean of 20,898 grains; under a diet of albumen, from 
12,325 to 21,592, with a mean of 17,738 grains ; under a diet of 
starch, from 14,339 to 23,352, with a mean of 18,427 grains ; and 
under a diet of gum, from 20,516 to 23,721 grains, with a mean 
of 21,538 grains. 

The only accurate method of determining whether or not the 
urine be increased or diminished, is, to refer it to the standard 
of health, in the individual examined. In hospital practice this 
is, in the majory of cases, impossible, and we are compelled to 
be content with approximate results. 

In this case, during fever and under the action of sulphate of 
quinia, the uric acid teas greatly diminished, and on the other hand, 
when the fever declined, and the action of the sulphate of quinia 
ceased, the amount of uric acid increased beyond the normal standard. 



1858.] Jones, on Malarial Fever. 385 

From the microscopical and chemical examination of several 
hundred specimens of urine excreted during the different forms 
of malarial fever, I found it, as a general rule, to be true, that 
in the mode of treatment which I adopted, the uric acid appears 
in much larger quantities in the urine of convalescence, than in 
that excreted during the fever, even when the sulphate of qui- 
nia had been withheld, or sparingly administered The major- 
ity of specimens of urine excreted during fever, which were set 
aside and examined, under the microscope, at successive inter- 
vals, gave no deposits of the crystals or salts of uric acid, whilst 
specimens of the urine of convalescence very soon gave evidence 
of the presence of uric acid, by letting fall deposits of urate of 
soda and ammonia. 

These facts explain the nature of the so-called critical discharges 
of malarial fever. The urine excreted during fever is generally de- 
ficient in uric acid and the earthy salts, whilst its acidity is increas- 
ed, and it will remain for a great length of time ivithout undergoing 
decomposition. flfe 

The urine of convalescence, on tJte other hand, is rich in uric acid 
and the earthy and alkaline salts, and readily undergoes decomposi- 
tion. The deposit of the urates of soda and ammonia, and the pre- 
cipitation of the triple phosphate, by the ammonia generated during 
decomposition of the urea, form the so-called critical discharges. 

As a general rule, the urine excreted during the hot stage of 
intermittent fever, is poorer in uric acid than the urine of remit- 
tent fever, and I have known cases in which, daring fever, the 
uric acid disappeared almost entirely. 

In several cases of congestive fever, the urine contained only 
traces of uric acid, and in one case, which terminated fatally, the 
disappearance of the uric acid was attended with the disappear- 
ance of the urea. 

Dr. Ranke ( 4 ) slates in Ms article vjpon the physiological action of 
sulphate of quinia, that according to all observers, there is in ague an in- 
crease of uric acid. My observations do not correspond with this asser- 
tion, if it is intended to apply to the active stages of intermittent, remittent 
and congestive fevers. The fact that uric acid increases during conva- 
lescence from malarial fever, demonstrates conclusively that the diminu- 
tion of the amount of uric acid by sulphate of quinia is an attending 
circumstance, and not necessarily one of the beneficial, remedial modes of 
the action of this medicine. 

Case II. — Englishman : entered the Savannah Marine Hos- 
pital Oct 9th, 1857 ; age 27. Has been in America thirteen 
years. Height 5 feet 10 inches ; weight 145 lbs. ; muscular sys- 

(4) Medical Times and Gazette, May 30, 1858, p. 537. 



386 



Jones, on Malarial Fever. 



[June, 



J 



tern well developed ; sanguine temperament. Occupation, stew- 
ard on ship. Has been in Savannah three weeks. 

Says that he was taken yesterday at 12 o'clock M., with cold 
feelings and headache. The chilly feelings lasted four hours, 
and were succeeded by fever, which continued until 4 o'clock 
A. M. this morning. Two and a half hours after the subsidence 
of the fever (8 J o'clock A. M.), he shook violently. This chill 
was followed by fever. 

Now, 8 o'clock P. M., fever is subsiding. 

Pulse 98, full but soft. 

Temperature of Atmosphere, 72°F. 

" " Hand, 102°5' 

" under Tongue, 103 

Tongue moist ; skin in a profuse perspiration. 

Says that he took, last evening, a dose of salts and cream of 
tartar, which operated twice this morning. 

3. When fever goes off, give sulphate of quinia, grs. v., every 
three hours, up to grs. xx. 

October 10th, 12 o'clock M. Vhere was a complete intermis- 
sion of the fever about 2 o'clock A. M. this morning. At this 
time the sulphate of quinia was commenced, and he has taken 
grs. xv. 

Amount of urine passed the last 16 hours, grs. 6,144. 
" " " hourly, grs. 321-5 

Calculated amount of urine for 24 hours, grs. 9,216. 



analysis i. 



In grs. 6,144 of 
Urine (16 hrs.) 



In grs. 9,216, cal- 
culated for 24 hrs. 



In 1000 parts of 
urine, 



Urea, 

Uric Acid, 

Fixed Saline Constituents, 



226-980 

0-600 

40-200 



340-470 

0-900 

60-100 



36-943 
0-097 
6-542 



Specific gravity of urine 1024 — clear, no deposit, light red 
color. Keaction decidedly acid. 

Microscopical examination of urine. 

After Standing 12 hours, no deposit. 

" " 36 " a very slight, light yellow deposit. 

After standing 60 hours, the surface was covered with a pel- 
licle, which under a magnifying power, of 210 diameters, was 
found to consist of small oval cells, about the size of the human 
blood corpuscle. There were also other elongated elliptical cells, 
the short diameters of which did not differ from those of the 
globular cells. Many of the elongated cells had a vibratory 
motion. The deposit at the bottom consisted of these globular 
elliptical acicular cells, and a few crystals of triple phosphate. 

That these cells were organized bodies, was demonstrated by 



• 



1858.] Jones, on Malarial Fever. 387 

the action of chemical re-agents under the microscope. Not a 
trace of uric acid was found in the pellicle and deposit. The 
bottle containing the urine had been kept closely stopped. 

12i o'clock, P.M. — A chill is just coming on. The thermo- 
meter, placed in his hand, indicated 91^° F. Simultaneously 
with the increase of the chill, it commenced to descend, and in 
15 minutes stood at 87j°. 

In 15 minutes his hand lost 4° F. He feels very cold, but 
does not shake. The extremities feel cold, whilst the surface 
of the head and trunk feel hot and pungent. When the bulb of 
the thermometer was simply placed between the skin and flannel 
shirt, and gently pressed against the surface of the chest, it 
commenced to rise rapidly and in a few moments indicated 
103° F. i 

When placed in the arm-pit, it rose rapidly to 107° F. 

Pulse 100 ; not so full as during fever, but small and threaded. 

Eespiration 26, full thoracic. 

Temperature of Atmosphere, 68°5' F. 

11 Hand, 87°5 ; 

in Axilla, 107 

Tongue pointed, but moist, and not much redder than usual. 
Skin dry, with a purplish mottled appearance, as if the circula- 
tion in the capillaries was retarded. Says that he has " dull 
pains wandering around his loins up to his chest." Complains of 
great thirst. His stomach is so irritable that I could not ascer- 
tain the temperature under his tongue. I made seven un- 
successful attempts. At every trial the contact of the bulb of 
the thermometer, with the base of the tongue, excited violent 
retching and vomiting. I applied a sinapism over the region of 
the spinal column, 18 inches in length, and 3 inches in breadth, 
also, one over the epigastrium, and administered brandy and 
snake-root tea, f 5ij. The brandy and snake-root tea were vo- 
mited up in a few moments. In half an hour alter their appli- 
cation, the mustards aroused the capillary circulation in the 
extremities. 

His surface does not present the mottled appearance ; the heat 
has in a great measure returned to his extremities, the cold 
sensations have disappeared, and "he feels warm all over." 
The temperature of his hand is now 99°. In half an hour, the 
temperature of his extremities has risen 11°5'. The temperature 
under the arm pit is still 107°. 

The temperature of the hand does not correspond fully with 
that of the trunk, and reaction is not yet fully established. 

Has just passed urine. Clear, limpid, of a light straw color. 
Reaction acid. Specific gravity 1003. Amount of urine void- 
ed, grains 7021. 



388 Jones, on 


Malarial Fever. 




[June, 




ANALYSIS II. 


7021 grains of Urine 
contained, 


lOOC 


parts of Urine 
contained, 


Urea, 

Uric Acid, 

Fixed Saline Constituents, 


39-551 
0-420 
9-800 


5-650 
0-059 
1-395 



J 



Nitrate of urea remarkably silky and white. 

Microscopical Examination. — The urine was poured into a 
closely stopped bottle, and set aside for 60 hours. At the end 
of this time the surface had a pellicle, and there was a small, 
light yellow deposit. 

The pellicle consisted entirely of the globular, elliptical and 
vibrating cells, observed in the former specimen. The deposit 
also consisted of these cells, and a few, beautifully formed, prys- 
matic crystals of triple phosphate. 

The fact, that the bottle was kept closely stopped, does not 
prove that the germs of these cells originated in the urine, for 
the bottle, in which the urine was first deposited, remained open 
during the voiding of the bladder, and the germs of these vegeta- 
ble bodies were, without doubt, then received from the atmos- 
phere. 

This specimen of urine is interesting, because it was passed at 
the close of a chill, and was probably excreted by the kidneys, 
during the existence of the cold stage. It was much lighter in 
color than that passed during fever : in fact, it resembled the 
urine of hysterical women, in its light color and low specific 
gravity. The urea and uric acid were diminished, whilst the fixed sa- 
line constituents were relatively increased. 

If the diminution of the uric acid was due to the action of the 15 grains 
of sulphate of quinia, which he took this morning, then the fact is demon- 
strated that the diminution of the amount of uric acid oy the sulphate of 
quinia, has nothing to do with the cure of intermittent fever. 
v $. During fever, give soda powders. As soon as fever re- 

mits, give sulphate of quinia, grs. v., every three hours, up to 
grs. xxx. Do not wait for the complete intermission of the fever. 
Diet, gruel and flaxseed tea. 

7 o'clock P. M. The fever is abating, and his skin is in a 
slight moisture. The circulation is fuller and more regular, and 
the temperature more equally distributed. 

Temperature of Atmosphere, 67°F. 

" Hand, 102 

Amount of urine passed since 12| P. M., (6^ hours,) grs. 5,075 ; 
high colored, resembling new madeira wine. Keaction decided- 
ly acid. 

Specific gravity 1015. 



1858.] 



Jones, on Malarial Fever. 



389 



Nitrate of urea white, silvery. 

Amount of urine excreted hourly, during last 6} hours, grs. 
780. 

Calculated amount of urine for 24 hours, grs. 20,300. 

Actual amount of urine excreted during the last 24 hours, 
grs. 18,240. 

Amount of urine excreted hourly during the last 24 hours,, 
grs. 760. 



ANALYSIS IIL 



5075 grs. of Urine, 
passed in 61-2 hrs. 
contained grains. 



Urea, . . . 
Uric Acid, . 
Fixed Saline 
Constituents. 



99-425 
0-250 

28-500 



20,300 grs. calculated 
amount of Urine for 
24 hrs. contain'd grs. 



397-700 
1-000 

114-000 



1000 pts. of 
Urine, con 
tained grs. 



18,240 grs of Urine, 
passed during last 
24 hrs. cont'd grs. 



19-586 
0-049 

5-615 



365-956 
1-270 

78-500 



Microscopical examination of the last specimen of urine ex- 
creted during the last 6} hours, up to 7 o'clock P. M. 

After standing 60 hours a slight deposit fell, consisting of the 
vegetable cells, previously described, and prismatic crystals of 
triple phosphate. 

Chemical reagents failed to give any evidence of the presence 
of uric acid in this deposit. His fever still continues. This 
specimen of urine therefore was excreted during fever. The 
patient has taken no sulphate of quinia since 11 o'clock A. M., 
this morning. 

It is important to note, that, in this case, the uric acid is diminished, 
both in the cold and hot stages. 

October 11th, 10} o'clock, A.M. — Says that he is much better. 
There was a complete intermission of the fever this morning, at 
5 o'clock, A.M. The subsidence of the febrile excitement was 
attended with a profuse perspiration, which continued up to 8 
o'clock, A.M. At the present time his pulse is 88, and respira- 
tion 22. Tongue moist and soft ; skin relaxed and soft ; bowels 
were moved this morning. 

Has taken 20 grains of sulphate of quinia since the intermis- 
sion of the fever. 

ty Sulphate of quinia, grains v. ty Snake-root tea f Sxviij, 
sulphate of quinia grains xv : mix. One tablespoonful every 
four hours. Half diet: beef soup, rice and tea. 

Amount of urine passed during the last 15} hours, grs. 9144. 

Specific gravity, 1^16. 

Amount of urine passed hourly during the last 15} hours, 
grs. 590- 

Calculated amount of urine for 24 hours, grs. 14630. 



390 Jones, on Malarial Fever. 


[June, 




ANALYSIS IV. 


9144 grains Urine 
excreted during 
last 15>£ hours, 
contained, grs. 


14620 grains Urine 
calculated for 24 
hours, contain- 
ed, grains, 


1000 parts Urine 
contained 


Urea, 

Uric Acid, 

Fixed Saline Constituents, 


157-140 

3150 

40-500 


251-424 

5-040 

64-800 


17-185 
0-344 
4-429 



Chemical and microscopical examination of the urine passed 
during the last 15£ hours. Specific gravity 1016. Color, deep 
orange inclining to red, with a heavy, light-yellow deposit. 
Eeaction alkaline. It has changed rapidly from acid to alkaline 
since it was voided. This is characteristic of the urine excreted dur- 
ing convalescence from intermittent fever. During the active stages of 
malarial f ever, the urine is always decidedly acid, and retains this reac- 
tion for many hours, and in severe cases, for several days, even in the 
heat of summer. When the fever intermits and the skin is moist and re- 
laxed, and the patient is convalescent, the urine then excreted, rapidly 
undergoes decomposition, dnd in a few hours the reaction changes from 
acid to alkaline. I believe this to be one of the most certain 
signs of convalescence in malarial fever. 

The deposit in this specimen of urine was found, under the 
microscope, to consist of well formed, prismatic crystals of triple 
phosphate, and globular acicular crystals of urate of soda, and 
the globular and elliptical cells previously described. When 
the deposit was treated with hydrochloric and acetic acids, un- 
der the microscope, an abundant crop of crystals of uric acid 
appeared. This is the first specimen of urine in which the de- 
posits have contained uric acid. 

The chemical analysis of the urine also shows that the uric acid is more 
abundant than in the urine of the hot and cold stages, notwithstanding that 
the patient was under the influence of 20 grains of sulphate ofquinia. 

October 12th, 11 o'clock, A. M. — Continues to improve. 
Missed the chill, but had a slight fever in the evening. 

Pulse 84. Eespiration 20. Countenance, complexion, skin, 
and temperature, normal. 

$ Quassia and soda. Continue snake-root tea : full diet. 

The urine through mistake was not preserved for examination. 

1\ o'clock, P. M. — Pulse 92; skin moist and cool. 

Amount of urine passed during the last 9 hours, grs. 15120. 

Specific gravity 1008. Orange color. 

Amount of urine passed during each hour, grs. 1680. 

Calculated amount of urine for 24 hours, grs. 40219. 

October 13th, 10 o'clock, A. M. — Says that he is quite well. 
Had no fever last night, and rested well. Tongue and skin 
normal in appearance ; reaction of saliva slightly acid ; during 
the height of the fever, it was decidedly acid. 



1858.] 



JoXES, on Malarial Fever. 



391 



Respiration 16. Pulse 68. 

Temperature of Atmosphere, 78°F. 

"Hand, 98 

" under Tongue, 99 

Amount of urine excreted during last 14^ hours, grs. 13662, 

Specific gravity, 1012. 

Amount of urine excreted hourly, grs. 942. 

Calculated amount of urine for 24 hours, grs. 21859. 

Amount of urine excreted hourly during the last 24 hours, 
grs. 1199. 

Actual amount of urine excreted during last 24 hours, grs. 
28782. 



ANALYSIS V. 


13662 grs. of Urine 
excreted in 11% 
hours, contain- 
grains, 


21859 grs. of Urine 
calculated for 24 
hours, contained 
grains. 


100 parts of Urine 
contained, 


Urea, 

Uric Acid, 

Fixed Saline Constituents, 


101-850 

2-025 

29-700 


162-960 

3-240 

47-520 


7-188 
0-148 
2-173 



Reaction of the urine alkaline, in 12 hours; color normal; 
light yellow deposit. Under the microscope, this deposit con- 
sisted of a few prismatic crystals of triple phosphate, globular 
crystals of urate of soda, and vegetable cells. 

October 15th. — Dressed up and walking in the hospital yard. 

Pulse 64. Respiration 16. Reaction of saliva, slightly alka- 
line. 

Amount of urine passed during the last 24 hours, grs. 16320. 

Color normal ; no deposit in 18 hours. Specific gravity 1020. 

Reaction acid. Urine excreted hourly, grs. 680. 



ANALYSIS VI. 


Grains 16820 of Urine ex- 
creted in 24 hours, 
contained, grains, 


1000 parts of Urine con- 
tained, 


Urea, 

Uric Acid, 

Fixed Saline Constituents, 


488-880 

9-600 

115.200 


29-818 
0-588 
7-058 



The patient had no return of fever, and was discharged the / 
next day. 

The following table will present a condensed view of the re- 
sults obtained. 



't^UOJ^ 



cnto ton 



TflUOJ^ JO ^UQ 




<S .O^ 



iC«(ijo.moH 



•axioiaapj 



o o 



3 5 



a 



£-2-3 3 
o o 



g a 3 



'King 50 3XVX§ 



eepj 



•uoi^Jidsay; 



• ' * •gjgijdsouriy jo a.m^Jaduiaj, 



•pa^if jo aan^iadraajQ 



•anSuoj, Japuti eatvituadarex 



OS CO Ol eo 
CO (35 '-' »-* 

toot to^ 
O to o ^ 



sanoi{ ^3 UT P a 

■^9.10X9 eui.ij} jd^unotny 



-saq f g tit pa^9J0X9 usafi 



s.moq 

f g ui p9}9jox9 ppy oi.ifl 



sanoq t5 ui 

s^uatvji'isuoQ atnjtfg paxyj 



UI p9;9.I0X9 9XIUX1 



w 
w 



"sanojj 



o o o o 

O K> 00 O 



o> o 
o to 
o o» 



•^TABJf) OUlDedg 



"B9JX1 



ppy ouq 



oo *»- oo to 
o to o o 



to tf*. l- 1 

H-" O rf»- 

oo to <3» 



S: S 



'S^TOtVjpSUOQ 8UITB g p9XTj[ 



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1858.] Jones, on Malarial Fever. 393 

The most striking phenomena in this case were those mani- 
fested during the cold stage. The temperature of the extremi- 
ties was 19^ degrees below that of the trunk. The temperature 
of the trunk was elevated 8 degrees above, while the tempera 
ture of the extremities was depressed 10 £ degrees below the 
normal standard. 

Similar phenomena have been manifested by every case of 
intermittent fever which I have examined during the cold stage. 

The phenomena of the cold stage will be illustrated by the 
following cases, which were carefully examined, just as they 
occurred in the hospital, without any selection. 

Case III. — Seaman : aged 55, height 5 feet 4 inches, small, 
spare man. Has been in the hospital for several months, suffer- 
ing with an affection of the eyes. 

This case has originated in the hospital. 

Chill came on one hour ago : he is still shaking violently, 
and his lips and hands look blue. Pulse 100. Kespiration 36 
to 50, varies with each quarter of a minute ; irregular, thoracic, 
labored. 

Temperature of Atmosphere, 71°5' F. 

" Hand, 92° 

'•' under Tongue, 104° 

Case IV. — Seaman: aged 38, height 5 feet 8 inches, light 
hair, blue eyes, sallow complexion. Looks as if his liver was 
out of order. Says that he " has had chills off and on from the 
16th of July to the present time, October 12th." His first attack 
of intermittent fever was contracted in the swamps of the Peedee 
River, S. C. Tongue clean and pale ; lips pale, anaemic. This 
patient presents the true malarial hue, and his blood is deficient 
in colored corpuscles. In the present attack of intermittent 
fever, he has a chill every day. 

October 12th. — This morning had a chill, followed by hot 
fever. During the febrile excitement, his pulse was 108 and his 
respiration 32 to the minute. As soon as the fever remitted, 
xx grs. of sulphate of quinia were administered. The sulphate 
of quinia delayed the chill ; it did not appear at the regular hour 
on the 13th inst., but came on at 4 o'clock, P.M., on the 14th inst. 

I commenced the examination about 15 minutes after the com- 
mencement of the chill. Lips and fingers pale, and of a bluish 
color ; extremities cold, whilst the trunk is hot to the touch. 
Patient is shaking all over. 

Pulse 92, feeble. Respiration 32, thoracic, labored. 

Temperature of Atmosphere, 77° 5' F. 

" Hand, 91 

" under Tongue, 103 



Jones, on Malarial Fever. [June, 

A small amouut of urine was excreted at the close of the cold 
stage, and commencement of the general elevation of tempera- 
ture, (equalization of the actions of the general and capillary 
circulation,) which had a normal color. Specific gravity 1023, 
and decided acid reaction, and under analysis exhibited a large 
increase of uric acid. 

Analysis viii. — 1000 parts of urine contained Urea, 21-825 
— Uric acid, 1*467 — Fixed saline constituents, 7436. 

This specimen of urine is in striking contrast with that ex- 
creted, under precisely similar circumstances, in Case ii. During 
the sweating stage the reaction of his skin was neutral. As a 
general rule, I have found it to be acid in the various forms of 
malarial fever. Eeaction of saliva, as usual, acid. 

October 15th. Complete intermission of fever. 

Pulse 80, fuller. Respiration 20, regular. 

Temperature of Atmosphere, 71°5'F. 

" Hand, 96 

" under Tongue, 98 

/ 

"1/ Case V. — Frenchman, aged 45 : brown hair and eyes ; height 

5 feet 7 inches; weight 130 lbs. Thin, spare man. Had an 
attack of intermittent fever, commencing Sept. 15th. 

This case was treated in the Savannah Poor House, and yield- 
ed to the ordinary remedies, and the patient was discharged in 
the course of ten days. He returned to a miasmatic situation, 
on the Savannah river, and was attacked again with intermit- 
tent fever. He entered the Hospital and Poor House Oct. 7th, 
and stated that for the last four days, he had had ■'dumb ague," 
which came on every day at the same hour, (11 o'clock A. M.,) 
and lasted two hours. 

A purgative, followed by xxv. grains of sulphate of quinia, 
was administered. This delayed the "dumb ague" until Oct. 
9th, 3i o'clock P. M. (28 hours). 

Examination commenced half an hour after the commence- 
ment of the " dumb ague." Lips and fingers purplish ; extremities 
cold ; head and trunk warm. Complains greatly of the sensa- 
tions of cold, but shakes far less than in the former cases 
recorded. 

Pulse 92, so feeble that it is with difficulty felt, and with still 
greater difficulty counted. The vibrations of the pulse resemble 
those of a fine thread. Respiration accelerated and irregular. 

Temperature of Atmosphere, 75° F. 

" " Hand, 83 

" under Tongue, 101° 5' 

6| o'clock P. M. Reaction has taken place, and he now has 
fever. 

Pulse 96, much fuller than during the chill, but weaker than 
in a frank open case. 



1858.] Jones, on Malarial Fever. 395 

Temperature of Atmosphere, 70° F. 

" " Hand, 101° 75' 

under Tongue, . . 102° 75' 

In this case, which was far more serious than any which we 
have yet recorded, the urine was of a high color and specific 
gravity, and correspondingly rich in urea and extractive mat- 
ters. The uric acid was slightly increased. 
Oct. 10th. Intermission of fever. 

Temperature of Atmosphere, 70° F. 

" Hand, 97° 5' 

" under Tongue, 98° 5' 

Case YI. — Irishman ; black hair, black eyes ; height 5 feet 
10 inches ; weight 150 lbs. In health, florid cAnplexion. 

Has been suffering with intermittent fever for four days. 
Chills have been slight. The present chill (Sept. 23d) is slight. 

Temperature of Atmosphere, 79°F. 

" " Hand, 90 

" under Tongue, 102 

Case VII. — Seaman — Englishman : brown hair, brown eyes ; 
florid complexion in health, now his complexion is anaemic ; 
weight 146 lbs. ; age 25 ; height 5 feet 6 inches. 

Sept. 10th. Entered the Savannah Marine Hospital, with 
bilious remittent fever, and from this date until the 19th inst. 
was extremely ill. 

This patient recovered so as to be able to walk about the 
hospital yard. jSTotwithstanding the administration of tonics 
and iron, his complexion was pale, anaemic, and he complained 
of a severe and continual pain in his head. 

Cut cups, external applications and internal remedies, failed 
to relieve the pain in his head. On the 4th of October he was 
taken with a severe chill, followed by high fever. This returned 
every day. 

Oct. 6th. The chill has been on him one hour, and the hot 
stage is just coming on. Pulse 110, feebler than after the com- 
plete reaction, but stronger than during the lowest depression 
of the cold stage. Kespiration irregular, thoracic, panting — 
45-50. Muscles trembling violently. 

Temperature of Atmosphere, 70°F. 

" Hand, , ... 97 

" under Tongue, 104 

Case VIII. — Irish laborer : stout, well formed man ; sanguine 
temperament ; light hair, blue eyes, florid complexion ; height 
5 feet 9 inches ; weight 190 lbs. 

This is his second attack of chill and fever this season. 

V. B. — VOL. XTV. FO. VI. 18 



396 Jones, on Malarial Fever. [June, 

Sept. 18th, 11 A. M. Chill is now just going off. Pulse 112. 
Respiration 28. 

Temperature of Atmosphere, 90° 5' F. 

" Hand, 100 

" under Tongue, ..*.,... 104 
Sept. 19th, 2 P. M. Apyrexia complete. Pulse 68. Respi- 
ration 24. 

Temperature of Atmosphere, 91° F. 

" Hand, 97° 5' 

" under Tongue, 99 

Recovered from this attack — commenced work upon a steam 
Tug, and slept on board, in the Savannah river, at night. Re- 
turned to the hospital with a third attack of intermittent fever. 

October 2nd,^ P. M. Has a chill and is shaking violently. 
Pulse 120, in sitting posture. Respiration 22, in sitting posture. 

Temperature of Atmosphere, 79° F. 

" Hand, 89 

" under Tongue, 102° 25' 

Oct. 3rd, 2 P. M. Has high fever. Pulse 100. Respiration 
26, thoracic. 

Temperature of Atmosphere, 77 a 5' F. 

" " Hand, 105 

11 under Tongue, 106 

Oct. 4th, 2 P. M. Apyrexia complete. Pulse 58. Respira- 
tion 20. 

Temperature of Atmosphere, . . . . . . . . 76° F. 

"